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General NPI Number Information
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NPI Number | 1134542582
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Entity Type | Organization
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Legal Business Name | FAMILYLOVE211
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 393 E RIVERSIDE DR STE 3A
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City | ST GEORGE
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State | UT
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Zip | 84790-7127
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Country | US
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Telephone | 435-068-8212
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Fax |
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Provider Business Mailing Address
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Address Line | 393 EAST RIVERSIDE DR BLDG 3A
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City | ST GEORGE
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State | UT
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Zip | 84790
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Country | US
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Telephone | 435-068-8212
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. NANCY JANE JENKINS
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Credential | PHD
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Telephone | 801-949-1323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 3588446004
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License Number State | UT
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