| NPI | 1023709755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE CASTILLO Licensed Clinical Social Worker 801-900-7558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2023-05-15 |