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General NPI Number Information
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NPI Number | 1225449630
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Entity Type | Organization
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Legal Business Name | YOUTHTRACK, INC
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 862 S MAIN SUITE 4
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City | BRIGHAM CITY
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State | UT
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Zip | 84302
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Country | US
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Telephone | 435-723-1799
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Fax |
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Provider Business Mailing Address
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Address Line | 862 S MAIN STREET
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City | BRIGHAM CITY
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State | UT
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Zip | 84302
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Country | US
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Telephone | 435-723-1799
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. KEVIN N BARLOW
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Credential |
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Telephone | 435-723-9442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 3636523902
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License Number State | UT
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