Organization Name: | ST. JOHN THERAPEUTIC SERVICES INC. |
NPI Number: | 1104078229 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FRANK J MERCIK (CEO) |
Mailing Address: | 555 E 5300 S Suite 6 South Ogden |
State: | UT US |
Postal Code: | 844054509 |
Phone Number: | 8016215385 |
Fax Number: | |
NPI Enumeration Date: | 10/21/2008 |
NPI Last Update Date: | 10/21/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 264211-3501 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |