Organization
SOULEGRIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER OLSEN (EXECUTIVE DIRECTOR)
(801) 285-6100
Entity
Organization
Contact information
Practice address
11 S MAIN ST, HURRICANE, UT 84737-1949
(800) 792-0435
(877) 698-4968
Mailing address
11 S MAIN ST, HURRICANE, UT 84737-1949
(800) 792-0435
(877) 698-4968
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
08/05/2020
Last updated
11/12/2021
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