Organization
BRAIN BODY BALANCE TREATMENT CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FORREST JIM WOLVERTON (OWNER)
(435) 767-8840
Entity
Organization
Contact information
Practice address
640 E 700 S STE 205A, SAINT GEORGE, UT 84770-4023
(435) 767-8840
(435) 359-5120
Mailing address
640 E 700 S STE 205A, SAINT GEORGE, UT 84770-4023
(435) 767-8840
(435) 359-5120
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730125956
—
UT
Enumeration date
07/20/2021
Last updated
11/16/2021
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