# MAGELLAN ACADEMY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053706358
- **Authorized official:** DR. PAUL WIEDERHOLD PH.D. (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (801) 794-0318

## Contact information

- **Practice address:** 704 N STATE ROAD 51, SPANISH FORK, UT 84660-1385
- **Practice address phone:** (801) 794-0318
- **Practice address fax:** (801) 794-9514
- **Mailing address:** 704 N STATE ROAD 51, SPANISH FORK, UT 84660-1385
- **Mailing address phone:** (801) 794-0318
- **Mailing address fax:** (801) 794-9514

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | UT | Yes |

## Other

- **Enumeration date:** 04/02/2015
- **Last updated:** 04/02/2015