Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Northstar Youth Academy LLC

Organization Children's Substance Abuse Rehabilitation Facility · NPI 1780782508

Northstar Youth Academy LLC is a Children's Substance Abuse Rehabilitation Facility in Provo, Utah. Licensed in Utah. Registered with an NPI since 2006.

Licensed in
UT
In the registry since
2006
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

900 Columbia Ln
Provo, UT 84604-1320
Phone: (801) 787-6194
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Children's Substance Abuse Rehabilitation Facility (primary) Taxonomy 3245S0500X · Licence 11932 (UT)

Record details

NPI number1780782508
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Banks Bourgeous — Co-Founder · (801) 369-4466
NPI enumeratedSeptember 20, 2006
Last updated in NPPESJuly 21, 2022
Mailing address920 Columbia Ln, Provo, UT 84604-1320

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