MEDICARE: MANDALA HEALING JOURNEYS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003615170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANDALA HEALING JOURNEYS

Provider Business Mailing Address
First Line	:	275 E SOUTH TEMPLE STE 250
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1273
Country	:	US
Telephone Number	:	801-900-4023
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 E SOUTH TEMPLE STE 250
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1273
Country	:	US
Telephone Number	:	801-900-4023
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW SIDOLI
Credential	:	LCSW
Telephone Number	:	505-504-0260

Provider Enumeration Date	:	03/11/2025
Last Update Date	:	04/28/2025

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