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Organization
THE CHILD'S ALLIANCE, LLC
Active
Organization
THE CHILD'S ALLIANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHANAEL WESLEY RIDGE PH.D., PA-C (OWNER)
(801) 448-8699
Entity
Organization
Contact information
Practice address
1909 S 4250 W OFC A, SALT LAKE CITY, UT 84104-4837
(801) 675-8777
(801) 852-0325
Mailing address
11721 S SILVER SPUR LN, DRAPER, UT 84020-4515
(801) 462-3925
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
363AM0700X
Medical Physician Assistant
Primary
—
NULL
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134424641
NPPES
UT
01
—
6833666-1206
DOPL
UT
01
—
6833666-2501
DOPL
UT
01
—
6833666-8906
DOPL
UT
Enumeration date
11/16/2023
Last updated
11/24/2023
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