| NPI | 1114434412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM ROSS MACKAY Manager 801-414-5894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 3289473501) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 3289473501) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2018-01-08 |