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Organization
WHITE RIVER ACADEMY
Active
Organization
WHITE RIVER ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN EDWARD NIELSON (PROGRAM DIRECTOR)
(435) 659-2368
Entity
Organization
Contact information
Practice address
275 W 100 S, DELTA, UT 84624-9238
(435) 659-2368
(435) 213-2810
Mailing address
275 W 100 S, DELTA, UT 84624-9238
(435) 659-2368
(435) 213-2810
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
NULL
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
NULL
Other
Enumeration date
03/01/2013
Last updated
10/16/2025
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