Healthcare Provider Details

I. General information

NPI: 1942081864
Provider Name (Legal Business Name): EMERGE TREATMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13751 S WADSWORTH PARK DR STE 103
DRAPER UT
84020-2103
US

IV. Provider business mailing address

24 W 1700 S UNIT C5
SALT LAKE CITY UT
84115-2387
US

V. Phone/Fax

Practice location:
  • Phone: 801-244-8497
  • Fax:
Mailing address:
  • Phone: 801-244-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MADISON HARPER
Title or Position: EXECUTIVE DIRECTOR
Credential: CMHC
Phone: 801-244-8497