| NPI | 1093984031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW G LARSON Owner 801-521-0699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 03609393501) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-02-25 |