Provider Demographics
NPI:1679311278
Name:GAIA'S WAY THERAPY LLC
Entity type:Organization
Organization Name:GAIA'S WAY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-619-2718
Mailing Address - Street 1:51 S. MAIN STR
Mailing Address - Street 2:BOX 460511
Mailing Address - City:LEEDS
Mailing Address - State:UT
Mailing Address - Zip Code:84746-7708
Mailing Address - Country:US
Mailing Address - Phone:435-619-2718
Mailing Address - Fax:
Practice Address - Street 1:40 N 300 E STE 101
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2900
Practice Address - Country:US
Practice Address - Phone:435-523-9395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty