Stacey Lynn Johanson
Individual provider Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Ephraim, UT
NPI 1194476895 · NPPES record last updated Jan 13, 2022
Key facts
- NPI
- 1194476895
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
- Practice address
- 66 N 180 W
Ephraim, UT 84627-2130 - Phone
- (435) 283-0164
- NPI assigned
- Jan 13, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Young Women'S Empowerment Center Long Term 3 | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | Yes |
Addresses
Primary practice location
66 N 180 W
Ephraim, UT 84627-2130
Mailing address
66 N 180 W
Ephraim, UT 84627-2130
Phone (435) 283-0164
Other providers in Ephraim, UT
- Ihc Health Service Inc
- Ihc Health Services Inc
- Stephanie Irons
- Donnell Marie Johansen
- Brian Charles Johanson
- Brett Alan Johnson
- Correen Johnson
- Jason W Jorgensen
- Journey Counseling Center Sanpete LLC the
- Linsey Nicole Keller
All providers in Ephraim, UT · Emotionally Disturbed Childrens' Residential Treatment Facility in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.