| NPI | 1124327788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JANN DEWITT Owner 801-510-4547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 308921-2501) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2011-03-22 |