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Organization
UTAH HOUSE
Active
Organization
UTAH HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALYCIA E JURGELA (CEO)
(801) 678-3317
Entity
Organization
Contact information
Practice address
1370 S WEST TEMPLE, SALT LAKE CITY, UT 84115-5218
(801) 678-3317
Mailing address
1713 QUARRY LN, MCKINNEY, TX 75072-5080
(801) 678-3317
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Enumeration date
03/18/2019
Last updated
06/11/2019
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