Organization
BLUE CHERRIES II LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY PECK KANE LCPC (DIRECTOR)
(702) 430-6206
Entity
Organization
Contact information
Practice address
9722 N 5650 W, HIGHLAND, UT 84003-3533
(801) 735-5971
Mailing address
9722 N 5650 W, HIGHLAND, UT 84003-3533
(702) 430-6206
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
01/07/2011
Last updated
12/27/2012
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