Organization
TEARACE ENT., LLC
Active
Other names
Your Life Launch
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDY K SODERQUIST LCSW (OWNER)
(435) 691-0856
Entity
Organization
Contact information
Practice address
1739 S HIGHWAY 89A, KANAB, UT 84741-3957
(928) 643-6000
(928) 643-6024
Mailing address
PO BOX 61, KANAB, UT 84741-0061
(928) 643-6000
(928) 643-6024
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
02/13/2019
Last updated
02/13/2019
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