| NPI | 1114277001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE J REALL Clinical Director / Owner 801-331-6775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: UT 139247-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 6819342-6004) |
| 1041C0700X Social Worker, Clinical (Licence: UT 5172018-3501) | |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2024-02-23 |