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Organization
GATEWAY ACADEMY, LLC
Active
Organization
GATEWAY ACADEMY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE EVANS (BO)
(801) 766-6604
Entity
Organization
Contact information
Practice address
1390 S 1100 E STE 203, SALT LAKE CITY, UT 84105-2463
(801) 523-3479
Mailing address
1390 S 1100 E STE 203, SALT LAKE CITY, UT 84105-2463
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
17567
UT
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
31810
UT
Other
Enumeration date
12/29/2015
Last updated
10/12/2016
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