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General NPI Number Information
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NPI Number | 1699420828
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Entity Type | Organization
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Legal Business Name | LEARNING SOLUTIONS ROOSEVELT
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 1360 W HIGHWAY 40 STE B
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City | VERNAL
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State | UT
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Zip | 84078-4203
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Country | US
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Telephone | 435-789-5683
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Fax |
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Provider Business Mailing Address
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Address Line | 1360 W HIGHWAY 40 STE B
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City | VERNAL
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State | UT
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Zip | 84078-4203
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Country | US
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Telephone | 435-789-5683
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. KEITH JAMES MEEKS
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Credential |
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Telephone | 435-621-1668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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