Provider Demographics
NPI:1033407606
Name:REDWOOD THERAPY AND YOUTH SERVICES
Entity Type:Organization
Organization Name:REDWOOD THERAPY AND YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADNEY
Authorized Official - Middle Name:MA'ANAIMA MARION
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-885-1216
Mailing Address - Street 1:154 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2359
Mailing Address - Country:US
Mailing Address - Phone:801-885-1216
Mailing Address - Fax:
Practice Address - Street 1:154 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2359
Practice Address - Country:US
Practice Address - Phone:801-885-1216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT18028251S00000X
UT18025253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health