| NPI | 1144204926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS FAIRBANK Pres/Owner 801-773-7177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2011-07-14 |