Provider Demographics
NPI:1386854461
Name:OUTBACK THERAPEUTIC EXPEDITIONS
Entity Type:Organization
Organization Name:OUTBACK THERAPEUTIC EXPEDITIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-766-3933
Mailing Address - Street 1:462 S 500 E
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-8125
Mailing Address - Country:US
Mailing Address - Phone:801-754-5311
Mailing Address - Fax:
Practice Address - Street 1:50 N 200 E
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1835
Practice Address - Country:US
Practice Address - Phone:801-766-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344193-3902322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children