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Stacey Lynn Johanson
Emotionally Disturbed Childrens' Residential Treatment Facility in Ephraim, Utah
NPI 1194476895

Stacey Lynn Johanson is a Emotionally Disturbed Childrens' Residential Treatment Facility based in Ephraim, UT. Stacey Lynn Johanson practices in Ephraim, UT. The NPI Number for Stacey Lynn Johanson is 1194476895 and holds a License No. (Utah).

The current practice location address for Stacey Lynn Johanson is 66 N 180 W, Ephraim, UT and can be reached out via phone at 435-283-0164.

Location: 66 N 180 W, Ephraim, UT, 84627-2130
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1194476895
Provider Name
Stacey Lynn Johanson
Credential
Provider Entity Type
Individual
Gender
Female
Address
66 N 180 W, Ephraim, UT, 84627-2130
Phone Number
435-283-0164
Fax Number
Provider Enumeration Date
01/13/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
66 N 180 W
City
Ephraim
State
Utah
Zip
84627-2130
Phone Number
435-283-0164
Fax Number
person
Provider Business Mailing Address Details
Address
66 N 180 W
City
Ephraim
State
Utah
Zip
84627-2130
Phone Number
435-283-0164
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Emotionally Disturbed Children
Speciality
-
Taxonomy
322D00000X
License No.
()
Definition
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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