MEDICARE: PROJECT REALITY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	364156-3501	UT

General Provider Information

NPI Number	:	1568419158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROJECT REALITY

Provider Business Mailing Address
First Line	:	150 E 700 S
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84111-3806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 E 700 S
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84111-3806
Country	:	US
Telephone Number	:	801-364-8080
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	DELBERT J FROST
Credential	:	LCSW
Telephone Number	:	801-364-8080

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/22/2020

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Directions to “PROJECT REALITY ” Practice Location

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