MEDICARE: SALT LAKE ADVOCACY AND COMMUNITY TRAINING

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	251S00000X	Community/Behavioral Health Agency	62551596009	UT
2	251B00000X	Case Management Agency	A00912	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1871601484	OTHER	UT	MENTAL HEALTH COUNSELING

General Provider Information

NPI Number	:	1871601484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALT LAKE ADVOCACY AND COMMUNITY TRAINING

Provider Business Mailing Address
First Line	:	3098 HIGHLAND DR STE 355
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3085
Country	:	US
Telephone Number	:	801-412-3798
Fax Number	:	801-486-4059

Provider Business Practice Location Address
First Line	:	3098 HIGHLAND DR STE 355
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3085
Country	:	US
Telephone Number	:	801-412-3798
Fax Number	:	801-486-4059

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. CYNTHIA PROCTOR
Credential	:	MC
Telephone Number	:	801-412-3798

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	06/17/2009

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Directions to “SALT LAKE ADVOCACY AND COMMUNITY TRAINING ” Practice Location

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