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Organization
RURAL THERAPY NETWORK
Active
Organization
RURAL THERAPY NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALIA KEALANA BURGESS (OWNER)
(406) 272-2440
Entity
Organization
Contact information
Practice address
343 N 300 W, SALT LAKE CITY, UT 84103-1215
(406) 272-2440
Mailing address
1935 W 4700 S # 322, TAYLORSVILLE, UT 84129-1105
(406) 272-2440
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
NULL
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
NULL
Other
Enumeration date
04/10/2024
Last updated
06/18/2024
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