Organization
CANYONLANDS COMMUNITY HEALTHCARE - BH
Active
Parent organization
CANYONLANDS COMMUNITY HEALTHCARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
CANYONLANDS COMMUNITY HEALTHCARE
Authorized official
ELIZABETH G LATHAM (CEO)
(928) 645-9675
Entity
Organization
Contact information
Practice address
467 VISTA AVENUE, PAGE, AZ 86040
(928) 645-9675
Mailing address
PO BOX 1625, PAGE, AZ 86040-1625
(928) 645-9675
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
BH-4088
AZ
103TC0700X
Clinical Psychologist
Primary
BH-4088
AZ
103TP0016X
Prescribing (Medical) Psychologist
BH-4088
AZ
103TP2701X
Group Psychotherapy Psychologist
BH-4088
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432857
—
AZ
Enumeration date
01/30/2013
Last updated
01/30/2013
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