| NPI | 1124729033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE STEPHEN GILLETT Manager 801-913-8795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2023-03-16 |