Tearace Ent., LLC

NPI #1326504523 in Kanab, Utah

Provider Information

NPI Number: 1326504523
Entity Type: Organization
Organization Name: Tearace Ent., LLC
Primary Specialty: Clinic/Center - Adolescent and Children Mental Health
Enumeration Date: Feb 13, 2019
Last Updated: Feb 13, 2019

Practice Location

Address: 1739 S HIGHWAY 89A
City: Kanab
State: Utah
ZIP Code: 84741-3957
Phone: (928) 643-6000

Authorized Official

Name: MR. RANDY K SODERQUIST, LCSW
Title: OWNER
Phone: (435) 691-0856

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Rehabilitation, Substance Use Disorder — Rehabilitation, Substance Use Disorder	261QR0405X
Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health	261QM0855X	Primary

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