| NPI | 1144737180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA RAE JOHNSON Owner 801-597-1340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 9210661-0160) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2018-06-16 |