Healthcare Provider Details

I. General information

NPI: 1821886318
Provider Name (Legal Business Name): EDUCELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 SPRING LN
CLARK FORK ID
83811-5502
US

IV. Provider business mailing address

265 SPRING LN
CLARK FORK ID
83811-5502
US

V. Phone/Fax

Practice location:
  • Phone: 801-755-7327
  • Fax:
Mailing address:
  • Phone: 801-755-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CADE DOPP
Title or Position: OWNER
Credential:
Phone: 801-755-7327