Organization
REGENESYS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL GAEDE PSYD, CMHC (DIRECTOR)
(801) 410-1671
Entity
Organization
Contact information
Practice address
1429 S 550 E, #4, OREM, UT 84097-7793
(801) 410-1671
Mailing address
1429 S 550 E, #4, OREM, UT 84097-7793
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
268792-6004
UT
Other
Enumeration date
03/17/2015
Last updated
03/17/2015
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