Provider Demographics
NPI:1003450602
Name:WINTCH PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:WINTCH PROFESSIONAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:WINTCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-647-1743
Mailing Address - Street 1:640 E 700 S STE 205B
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5773
Mailing Address - Country:US
Mailing Address - Phone:520-647-1743
Mailing Address - Fax:
Practice Address - Street 1:640 E 700 S STE 205B
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5773
Practice Address - Country:US
Practice Address - Phone:520-647-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health