| NPI | 1033684618 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DAVID ROACH Owner 801-860-7818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2018-10-10 |