Organization
UNIVERSAL HEALTH SYSTEMS
Active
Parent organization
PROVO CANYON SCHOOL
Other names
Provo Canyon School, Provo Canyon School
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVO CANYON SCHOOL
Authorized official
MAX AH QUIN CMHC (CLINICAL DIRECTOR)
(801) 932-2544
Entity
Organization
Contact information
Practice address
4501 N UNIVERSITY AVE, PROVO, UT 84604-5504
(801) 932-6364
Mailing address
4501 N UNIVERSITY AVE, PROVO, UT 84604-5504
(801) 932-2532
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
10/24/2019
Last updated
10/24/2019
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