NPIMap

Organization Active NPI

Eagle Ranch Academy

  • Community/Behavioral Health Agency
  • St George, UT
National Provider Identifier
1386194751
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
5360626 3904 Issued in UT
Legal business name
EAGLE RANCH ACADEMY
Practice address
91 W 1470 S
Suite 101
St George, UT 84770-6709
Phone
(435) 652-8488
NPI assigned
Oct 10, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Kelly Bawden, LMFT
Title
Clinical Director
Phone
(435) 922-0440

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 53606263904 UT
Community/Behavioral Health Agency 251S00000X 5360626 3904 UT Primary

Addresses

Primary practice location

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

Mailing address

91 W 1470 S
Suite 101
St George, UT 84770-6709
Phone (435) 652-8488

Other names 1

  • Eagle Ranch Outpatient Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eagle Ranch Outpatient Services3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

91 W 1470 S
Ste 101
St George, UT 84770
Phone (435) 652-8488

NPI Registry JSON

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1386194751",
    "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": "435-652-8488"
        },
        {
            "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": "435-652-8488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE RANCH ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "BAWDEN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "435-922-0440",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "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": [
        {
            "organization_name": "Eagle Ranch Outpatient Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St George, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.