Elements Wilderness Program

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

15403 Issued in UT

Legal business name

ELEMENTS WILDERNESS PROGRAM

Practice address

130 N Main Street
Huntington, UT 84528

Phone

(801) 712-3372

NPI assigned

Feb 4, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary Covington

Title

Insurance Consultant

Phone

(801) 466-3838

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1013249713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5807 FONTAINE BLEU DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841211819",
            "telephone_number": "801-712-3372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 N MAIN STREET",
            "city": "HUNTINGTON",
            "state": "UT",
            "postal_code": "84528",
            "telephone_number": "801-712-3372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEMENTS WILDERNESS PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-04",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "COVINGTON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "INSURANCE CONSULTANT",
        "authorized_official_telephone_number": "801-466-3838",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "UT",
            "license": "15403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carbon Medical Service Association Incorporated
• Jeffery Paul Cowley, NP
• Elements Traverse LLC
• Ellsworth Foot and Ankle Clinic
• Emery Emergency Medical Special Service District
• Jeffrey J Freedlund, CSW
• Jacie Amanda Huntington, RDN, LN
• Stoney Jensen

• Emotionally Disturbed Childrens' Residential Treatment Facility in Huntington, UT
• Providers in Huntington, UT by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.