| NPI | 1063124451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BLAKE Owner 801-695-5057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2022-12-19 |