Organization
EAGLE RANCH OUTPATIENT SERVICES
Active
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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