Organization
MAGELLAN ACADEMY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL WIEDERHOLD PH.D. (EXECUTIVE DIRECTOR)
(801) 794-0318
Entity
Organization
Contact information
Practice address
704 N STATE ROAD 51, SPANISH FORK, UT 84660-1385
(801) 794-0318
(801) 794-9514
Mailing address
704 N STATE ROAD 51, SPANISH FORK, UT 84660-1385
(801) 794-0318
(801) 794-9514
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
UT
Other
Enumeration date
04/02/2015
Last updated
04/02/2015
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