Healthcare Provider Details

I. General information

NPI: 1871601484
Provider Name (Legal Business Name): SALT LAKE ADVOCACY AND COMMUNITY TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3098 HIGHLAND DR STE 355
SALT LAKE CITY UT
84106-3085
US

IV. Provider business mailing address

3098 HIGHLAND DR STE 355
SALT LAKE CITY UT
84106-3085
US

V. Phone/Fax

Practice location:
  • Phone: 801-412-3798
  • Fax: 801-486-4059
Mailing address:
  • Phone: 801-412-3798
  • Fax: 801-486-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberA00912
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number62551596009
License Number StateUT

VIII. Authorized Official

Name: MS. CYNTHIA PROCTOR
Title or Position: EXECUTIVE DIRECTOR
Credential: MC
Phone: 801-412-3798