| NPI | 1114353570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP LOUIS HANSEN Clinical Social Worker 801-944-1666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 139806-3501) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2013-09-17 |