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General NPI Number Information
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NPI Number | 1316141005
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Entity Type | Organization
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Legal Business Name | UTAH'S CHILDREN'S JUSTICE CENTER PROGRAM
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 84 N 200 W
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City | VERNAL
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State | UT
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Zip | 84078-2038
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Country | US
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Telephone | 435-781-0105
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Fax | 435-781-6573
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Provider Business Mailing Address
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Address Line | 5272 COLLEGE DR STE 200
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City | SALT LAKE CITY
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State | UT
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Zip | 84123-2772
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Country | US
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Telephone | 801-281-1238
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Fax | 801-281-1238
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Authorized Official
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Title or Position | CJC DEVELOPMENT & TRAINING COORDINA
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Name | LAURA SEKLEMIAN
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Credential |
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Telephone | 801-281-1238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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