Organization
SUNDANCE CANYON ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REYNIE THOMAS SANDOVAL LCSW (CLINICAL DIRECTOR)
(801) 735-6407
Entity
Organization
Contact information
Practice address
6948 DUSTY ROSE DR, HERRIMAN, UT 84096-4710
(801) 446-6206
(801) 446-6978
Mailing address
6948 DUSTY ROSE DR, HERRIMAN, UT 84096-4710
(801) 446-6206
(801) 446-6978
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
17166
UT
Other
Enumeration date
11/02/2010
Last updated
11/02/2010
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