MEDICARE: AUTISM JOURNEYS TREATMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	5095471-6004	UT
2	251S00000X	Community/Behavioral Health Agency	320820-4102	UT
3	251S00000X	Community/Behavioral Health Agency	5193889-2501	UT

General Provider Information

NPI Number	:	1386983740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM JOURNEYS TREATMENT CENTER

Provider Business Mailing Address
First Line	:	PO BOX 119
Second Line	:	AUTISM JOURNEYS
City	:	DRAPER
State	:	UT
Zip	:	84020-0119
Country	:	US
Telephone Number	:	801-938-9268
Fax Number	:	801-572-7460

Provider Business Practice Location Address
First Line	:	675 E 500 S
Second Line	:	SUITE 360
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2818
Country	:	US
Telephone Number	:	801-938-9268
Fax Number	:	801-572-7460

Authorized Official
Title or Position	:	PRESIDENT & FOUNDER
Name	:	KATE DAHLE ANDERSEN
Credential	:
Telephone Number	:	801-718-6441

Provider Enumeration Date	:	02/05/2013
Last Update Date	:	02/05/2013

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