NPI | 1154205755 |
---|---|
Entity Type | Organization |
Authorized Contact | CHARLES DECOSTER COO 435-680-9782 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
Additional Taxonomies | 163W00000X Registered Nurse |
163WP0808X Registered Nurse, Psych/Mental Health | |
207QA0505X Family Medicine, Adult Medicine | |
2084P0800X Psychiatry & Neurology, Psychiatry | |
Enumeration Date | 2025-08-05 |
Last Update Date | 2025-08-26 |