Organization
EAGLE RANCH ACADEMY
Active
Other names
Eagle Ranch Outpatient Services
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY BAWDEN LMFT (CLINICAL DIRECTOR)
(435) 922-0440
Entity
Organization
Contact information
Practice address
91 W 1470 S, SUITE 101, ST GEORGE, UT 84770-6709
(435) 652-8488
Mailing address
91 W 1470 S, SUITE 101, ST GEORGE, UT 84770-6709
(435) 652-8488
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
53606263904
UT
251S00000X
Community/Behavioral Health Agency
Primary
5360626 3904
UT
Other
Enumeration date
10/10/2016
Last updated
10/10/2016
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