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General NPI Number Information
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NPI Number | 1376492314
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Entity Type | Organization
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Legal Business Name | ADVENTURE THERAPY PROJECT
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 466 S 500 E STE 202
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-2705
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Country | US
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Telephone | 801-891-3874
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Fax |
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Provider Business Mailing Address
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Address Line | 3839 S WEST TEMPLE APT A518
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City | SOUTH SALT LAKE
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State | UT
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Zip | 84115-5641
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Country | US
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Telephone | 801-891-3874
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID WIEDER
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Credential | CMHC, LCPC
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Telephone | 801-891-3874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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