Healthcare Provider Details

I. General information

NPI: 1114404704
Provider Name (Legal Business Name): MONUMENTS ACADEMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 DRY LAKES ROAD
BRIAN HEAD UT
84719
US

IV. Provider business mailing address

150 N 200 E STE 200
ST GEORGE UT
84770-2514
US

V. Phone/Fax

Practice location:
  • Phone: 800-559-1980
  • Fax:
Mailing address:
  • Phone: 435-673-9479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BARTLETT
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: LMFT
Phone: 801-380-4390