Organization Name: | SAN JUAN MENTAL HEALTH-SUBSTANCE ABUSE SPECIAL SERVICE DISTRICT |
NPI Number: | 1356353692 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JED E. LYMAN (EXECUTIVE DIRECTOR) |
Mailing Address: | 356 S Main St Blanding |
State: | UT US |
Postal Code: | 845113830 |
Phone Number: | 4356782992 |
Fax Number: | 4356783116 |
NPI Enumeration Date: | 08/13/2006 |
NPI Last Update Date: | 06/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | 11054 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |