Healthcare Provider Details

I. General information

NPI: 1679311278
Provider Name (Legal Business Name): GAIA'S WAY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N 300 E STE 101
SAINT GEORGE UT
84770-2900
US

IV. Provider business mailing address

51 S. MAIN STR BOX 460511
LEEDS UT
84746-7708
US

V. Phone/Fax

Practice location:
  • Phone: 435-523-9395
  • Fax:
Mailing address:
  • Phone: 435-619-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TINA L CALL
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 435-619-2718