| NPI | 1043688872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBIE RICCARDELLI Owner 801-331-6775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: UT 369760-6004) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2015-09-10 |