| NPI | 1043243140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY K BATES CFO 801-625-3879 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 11257) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2020-08-22 |