| NPI | 1023834173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVY CHRISTIANSEN Owner/Operator 801-906-1074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2024-11-22 |
| Last Update Date | 2024-11-22 |