| NPI | 1134830193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA CARLSON Owner 801-671-5622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2022-12-12 |