| NPI | 1053910331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DAVID ROACH Executive Director 801-792-7028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2020-10-19 |