Provider Demographics
NPI:1659535243
Name:IKAE, INC
Entity Type:Organization
Organization Name:IKAE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IURI
Authorized Official - Middle Name:TIAGO
Authorized Official - Last Name:MELO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-986-1805
Mailing Address - Street 1:689 E SONORAN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8261
Mailing Address - Country:US
Mailing Address - Phone:435-986-1805
Mailing Address - Fax:
Practice Address - Street 1:640 E 700 S
Practice Address - Street 2:SUITE 207
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4023
Practice Address - Country:US
Practice Address - Phone:435-628-2718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52521653501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health