Organization
SAN JUAN MENTAL HEALTH-SUBSTANCE ABUSE SSD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN S. ROGERS LCSW (EXECUTIVE DIRECTOR)
(435) 678-2992
Entity
Organization
Contact information
Practice address
356 S MAIN ST, BLANDING, UT 84511-3830
(435) 678-2992
(435) 678-3116
Mailing address
356 S MAIN ST, BLANDING, UT 84511-3830
(435) 678-2992
(435) 678-3116
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
11054
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
876000546138
—
UT
Enumeration date
08/16/2006
Last updated
08/22/2020
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