| Project Reality | |
|
5282 S Commerce Dr Salt Lake City UT 84107-4785 | |
| (385) 881-0170 | |
| (385) 212-3234 |
| Full Name | Project Reality |
|---|---|
| Speciality | Counselor |
| Location | 5282 S Commerce Dr, Salt Lake City, Utah |
| Authorized Official Name and Position | Maureen Mary Collins (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8013648080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Project Reality Po Box 57098 Murray UT 84157-0098 Ph: (801) 364-8080 | Project Reality 5282 S Commerce Dr Salt Lake City UT 84107-4785 Ph: (385) 881-0170 |
| NPI Number | 1134211626 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 07/24/2024 |
| Certification Date | 07/24/2024 |
| Medicare PECOS PAC ID | 4082669825 |
|---|---|
| Medicare Enrollment ID | O20050315000564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134211626 | NPI | - | NPPES |
| Provider Name | Katherine L Carlson |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1770554115 PECOS PAC ID: 0042108839 Enrollment ID: I20040304000775 |
| Provider Name | Linda Gayle Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518130145 PECOS PAC ID: 4183679392 Enrollment ID: I20050321000358 |
| Provider Name | James D Green |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083000855 PECOS PAC ID: 1658689963 Enrollment ID: I20180830002980 |
| Provider Name | Matthew B Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710525266 PECOS PAC ID: 7517347123 Enrollment ID: I20220629000450 |
| Provider Name | Ivana Micic |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801238431 PECOS PAC ID: 6608256243 Enrollment ID: I20220629001737 |
| Provider Name | Dane Joseph Burns |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114596681 PECOS PAC ID: 3678953171 Enrollment ID: I20220630000116 |
| Provider Name | Holly Kaye Ancell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194209825 PECOS PAC ID: 6103206537 Enrollment ID: I20220701001731 |
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