| NPI | 1023537420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNA JEAN GILLEN Manager 435-849-0598 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 8161136-6004) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2017-09-18 |