| NPI | 1063173540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUSTIN MILLET Owner 801-921-0806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2022-01-06 |