Individual provider · Type 1 NPI
Stacey Lynn Johanson
Emotionally Disturbed Childrens' Residential Treatment Facility · Ephraim, UT
NPI number
1194476895
Active
Practice location
66 N 180 W
Ephraim, UT 84627-2130
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Emotionally Disturbed Childrens' Residential Treatment Facility Primary | 322D00000X | None listed |
Emotionally Disturbed Childrens' Residential Treatment Facility: A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.
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About NPI 1194476895
Stacey Lynn Johanson's National Provider Identifier is 1194476895, issued on Jan 13, 2022. The primary taxonomy on file is Emotionally Disturbed Childrens' Residential Treatment Facility (322D00000X), and the practice location is in Ephraim, UT. The record was last updated on Jan 13, 2022.