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General NPI Number Information
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NPI Number | 1760777221
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Entity Type | Organization
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Legal Business Name | PAINTED HILLS ACADEMY
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 680 WEST 300 SOUTH
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City | MILFORD
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State | UT
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Zip | 84751-0516
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Country | US
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Telephone | 855-861-2263
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Fax | 435-387-2499
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Provider Business Mailing Address
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Address Line | 680 WEST 300 SOUTH
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City | MILFORD
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State | UT
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Zip | 84751-0516
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Country | US
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Telephone | 855-861-2263
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Fax | 435-387-2499
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Authorized Official
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Title or Position | EXECUTIVE/CLINICAL DIRECTOR
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Name | SCOTT MICHAEL CECIL
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Credential | LPC
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Telephone | 885-861-2263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 18054
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License Number State | UT
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