Healthcare Provider Details

I. General information

NPI: 1134211626
Provider Name (Legal Business Name): PROJECT REALITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 S COMMERCE DR
SALT LAKE CITY UT
84107-4785
US

IV. Provider business mailing address

PO BOX 57098
MURRAY UT
84157-0098
US

V. Phone/Fax

Practice location:
  • Phone: 385-881-0170
  • Fax: 385-212-3234
Mailing address:
  • Phone: 801-364-8080
  • Fax: 801-364-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. MAUREEN MARY COLLINS
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 801-364-8080