| NPI | 1134359896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY G. OLSEN Owner 801-806-4226 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: UT 15464) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 15464) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: UT 15464) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: UT 15464) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2009-07-15 |