| NPI | 1255974085 |
|---|---|
| Doing Business As | PROVO CANYON SCHOOL |
| Other Name | PROVO CANYON SCHOOL |
| Entity Type | Organization |
| Authorized Contact | MAX AH QUIN Clinical Director 801-932-2544 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2019-10-24 |
| Last Update Date | 2019-10-24 |