Organization
EAGLE RANCH OUTPATIENT SERVICES
Active
Parent organization
EAGLE RANCH ACADEMY
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAGLE RANCH ACADEMY
Authorized official
KELLY BAWDEN LMFT (THERAPIST/DIRECTOR)
(435) 922-0440
Entity
Organization
Contact information
Practice address
91 W 1470 S, SUITE 101, ST GEORGE, UT 84770-6709
(435) 922-0440
Mailing address
91 W 1470 S, SUITE 101, ST GEORGE, UT 84770-6709
(435) 922-0440
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
53606263904
UT
101YA0400X
Addiction (Substance Use Disorder) Counselor
53606266006
UT
106H00000X
Marriage & Family Therapist
53606263904
UT
251S00000X
Community/Behavioral Health Agency
Primary
5360626 3904
UT
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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