Provider Demographics
NPI:1700168374
Name:EQUINE JOURNEYS, LLC
Entity Type:Organization
Organization Name:EQUINE JOURNEYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-836-2535
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:LOA
Mailing Address - State:UT
Mailing Address - Zip Code:84747-0069
Mailing Address - Country:US
Mailing Address - Phone:435-836-2535
Mailing Address - Fax:435-836-2537
Practice Address - Street 1:14 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LOA
Practice Address - State:UT
Practice Address - Zip Code:84747
Practice Address - Country:US
Practice Address - Phone:435-836-2535
Practice Address - Fax:435-836-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT18393322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children