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General NPI Number Information
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NPI Number | 1174338990
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Entity Type | Organization
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Legal Business Name | JOURNEY MENTAL HEALTH
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 1414 E 4500 S STE 3
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City | MILLCREEK
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State | UT
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Zip | 84117-4248
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Country | US
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Telephone | 385-299-0473
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Fax | 385-255-9235
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Provider Business Mailing Address
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Address Line | 1414 E 4500 S STE 3
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City | MILLCREEK
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State | UT
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Zip | 84117-4248
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Country | US
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Telephone | 385-299-0473
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Fax | 385-255-9235
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MICHAEL JOHN-PAUL RYAN
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Credential | APRN- FNP
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Telephone | 860-306-6067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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