MAKANA LEADERSHIP ACADEMY (NPI# 1467077750) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467077750 |
| Entity Type | Organization |
| Organization Name | MAKANA LEADERSHIP ACADEMY |
| Practice Address |
4270 W 5625 N Roosevelt UT 84066-4824 |
| Practice Telephone | 4353534498 |
| Practice Fax Number | 4353534898 |
| Mailing Telephone | 4353534498 |
| Mailing Fax Number | 4353534898 |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2020-06-11 |
| Authorized Official Name | MS. SHARON K SPERRY-CLEGG (COMPLIANCE DIRECTOR) |
| Authorized Official Telephone | 8018593505 |
| Authorized Official Credential | MA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 174200000X | Meals | Other Service Providers | ||
| N | 177F00000X | Lodging | Other Service Providers | ||
| N | 251B00000X | Case Management | Agencies | ||
| N | 310500000X | Intermediate Care Facility, Mental Illness | Nursing & Custodial Care Facilities | ||
| N | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities | ||
| N | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
Residential Treatment Facilities | ||
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| Street Address |
4270 W 5625 N |
| City | ROOSEVELT |
| State | UT |
| Zip Code | 84066-4824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801144746 | Jacob Auna | Social Worker | 4270 W 5625 N, Roosevelt, UT 84066-4824 | 2012-08-27 |
| 1083231203 | Lara Kravet | Social Worker | 4270 W 5625 N, Roosevelt, UT 84066-4824 | 2020-07-03 |
| 1851723209 | Robert A Nielson | Marriage & Family Therapist | 4270 W 5625 N, Roosevelt, UT 84066-4824 | 2013-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477075315 | Annemarie Rousseau | Registered Nurse | 250 West 300 North, Roosevelt, UT 84066 | 2017-07-12 |
| 1780036772 | Drew Gilley | Dentist | 375 E Lagoon St, Roosevelt, Ut 84066, Roosevelt, UT 84066 | 2016-07-01 |
| 1952758039 | Amanda Adams | Massage Therapist | 1151 East Hwy 40, Ballard, UT 84066 | 2016-05-19 |
| 1447624325 | Gregory George Page | Dentist | 209 West 200 North 71-2, Roosevelt, UT 84066 | 2015-11-16 |
| 1659785772 | Becky Ann Birch | Nurse Practitioner | 200 West 350 North, Ste 103, Roosevelt, UT 84066 | 2014-06-17 |
| 1760724280 | Novo Ranch LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3549 W 1000 North, Roosevelt, UT 84066 | 2013-03-22 |
| 1508110040 | Uintah Basin Spine and Disc Center, PC | Rehabilitation Unit | 1151 East Highway 40, Roosevelt, UT 84066 | 2012-11-06 |
| 1184918682 | Alvaro Beltran | Dentist | Ave. Lopez Mateos 171-4, Nogales, SONORA 84066 | 2011-06-02 |
| 1255638367 | Cosme Cantu | Dentist | Blvd. El Greco #45 Int. J-14, Nogales, SONORA 84066 | 2011-02-25 |
| 1740482009 | Northeastern Utah Medical Group | Durable Medical Equipment & Medical Supplies | 210 W 300 N 75 3, Roosevelt, UT 84066 | 2007-05-31 |
| Find all providers in zip 84066 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013478346 | Kintsugi Counseling, LLC | Clinic/Center | 150 N Main St Ste 204, Heber City, UT 84032-1671 | 2019-03-28 |
| 1265997746 | Summit Counseling Solutions | Clinic/Center | 4838 W Pillar Dr, Riverton, UT 84096-1428 | 2019-02-08 |
| 1528534401 | Bear Creek Counseling,llc | Clinic/Center | 1227 W 9000 S Ste H, West Jordan, UT 84088-9001 | 2018-10-18 |
| 1114404704 | Monuments Academy LLC | Clinic/Center | 1990 Dry Lakes Road, Brian Head, UT 84719 | 2018-07-26 |
| 1033606298 | Imperial Healing Estate | Clinic/Center | 4194 Imperial Way, Provo, UT 84604-5328 | 2018-04-13 |
| 1184133571 | Connected Life Counseling Center, LLC | Clinic/Center | 741 E 9000 S Ste 200d, Sandy, UT 84094-3085 | 2017-09-28 |
| 1790229185 | Rise Above Treatment Center | Clinic/Center | 1039 S Orem Blvd, Orem, UT 84058-6979 | 2016-12-05 |
| 1699220764 | Purple Sky Counseling, Pllc | Clinic/Center | 450 W 910 S Ste 12, Heber City, UT 84032-2447 | 2016-08-18 |
| 1164898409 | Joseph K Yau Md LLC | Clinic/Center | 2215 E High Ridge Ln, Sandy, UT 84092-4860 | 2015-08-20 |
| 1447643887 | Sundance Canyon Inc | Clinic/Center | 6948 W Dusty Rose Cir, Herriman, UT 84096-4710 | 2015-03-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.