Healthcare Provider Details

I. General information

NPI: 1477985513
Provider Name (Legal Business Name): SAINT ANTHONY HOUSE TREATMENT PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W 2700 S
SOUTH SALT LAKE UT
84115-2904
US

IV. Provider business mailing address

331 W 2700 S
SOUTH SALT LAKE UT
84115-2904
US

V. Phone/Fax

Practice location:
  • Phone: 801-678-3317
  • Fax:
Mailing address:
  • Phone: 801-678-3317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLIC201300573
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number20772
License Number StateUT
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number85193680160
License Number StateUT

VIII. Authorized Official

Name: ALYCIA ERIKA JURGELA
Title or Position: CEO
Credential: LPC
Phone: 801-678-3317