Eagle Ranch Outpatient Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

5360626 3904 Issued in UT

Legal business name

EAGLE RANCH OUTPATIENT SERVICES

Practice address

91 W 1470 S
Suite 101
St George, UT 84770-6709

Phone

(435) 922-0440

NPI assigned

Jul 26, 2016

Organization subpart

Yes

Parent organization

EAGLE RANCH ACADEMYAs reported in NPPES

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

Authorized official

Name

Kelly Bawden, LMFT

Title

Therapist/Director

Phone

(435) 922-0440

Specialties & licenses 4

Addresses

Tax ID family

Eagle Ranch Outpatient Services3 organizations share this tax ID, including this one

Part of

Eagle Ranch Outpatient Services

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Eagle Ranch Academy

  • Children's Substance Abuse Rehabilitation Facility
  • St George, UT
  • NPI 1003014648
  NPD tax ID
• Eagle Ranch Academy

  • Community/Behavioral Health Agency
  • St George, UT
  • NPI 1386194751
  NPD tax ID

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

{
    "created_epoch": "1469491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469491200000",
    "number": "1235682345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 W 1470 S",
            "address_2": "SUITE 101",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847706709",
            "telephone_number": "435-922-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 W 1470 S",
            "address_2": "SUITE 101",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847706709",
            "telephone_number": "435-922-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE RANCH OUTPATIENT SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGLE RANCH ACADEMY",
        "enumeration_date": "2016-07-26",
        "last_updated": "2016-07-26",
        "status": "A",
        "authorized_official_last_name": "BAWDEN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "THERAPIST/DIRECTOR",
        "authorized_official_telephone_number": "435-922-0440",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "UT",
            "license": "53606263904",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "UT",
            "license": "53606266006",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "UT",
            "license": "53606263904",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "UT",
            "license": "5360626 3904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Eads, RN
• Bryce Eagar, DDS
• Michael Eagar
• Eagle Ranch Academy
• Eagle Ranch Academy
• Kyle James Eardley, PA-C
• Mason Eardley
• Darren Boyd Earl, DMD
• Jacob Daniel Earl, OTR/L
• Martha Earl

• Community/Behavioral Health Agency in St George, UT
• Providers in St George, UT by specialty
• Community/Behavioral Health Agency in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; 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.