| NPI | 1386194751 |
|---|---|
| Doing Business As | EAGLE RANCH OUTPATIENT SERVICES |
| Entity Type | Organization |
| Authorized Contact | KELLY BAWDEN Clinical Director 435-922-0440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: UT 5360626 3904) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 53606263904) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-10-10 |