Healthcare Provider Details

I. General information

NPI: 1205115839
Provider Name (Legal Business Name): ARCADIA RECOVERY CENTER PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2011
Last Update Date: 08/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 SPENCER CREST DR
BLUFFDALE UT
84065-3048
US

IV. Provider business mailing address

806 S 1040 W
PAYSON UT
84651-4614
US

V. Phone/Fax

Practice location:
  • Phone: 801-709-9419
  • Fax:
Mailing address:
  • Phone: 801-709-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7760548-3502
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7760548-3502
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7760548-3502
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7760548-3502
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7760548-3502
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number7760548-3502
License Number StateUT
# 8
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7760548-3502
License Number StateUT

VIII. Authorized Official

Name: MR. DUSTIN JOSEPH LONG
Title or Position: EXECUTIVE DIRECTOR
Credential: RASI
Phone: 801-709-9419