Healthcare Provider Details

I. General information

NPI: 1134447899
Provider Name (Legal Business Name): ALLIANCE YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 E 1100 N
AMERICAN FORK UT
84003-3226
US

IV. Provider business mailing address

995 E 1100 N
AMERICAN FORK UT
84003-3226
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-8315
  • Fax: 801-763-8320
Mailing address:
  • Phone: 801-763-8315
  • Fax: 801-763-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number15691
License Number StateUT

VIII. Authorized Official

Name: MR. JAMES CURTIS OTTESON
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 801-763-8315