| 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 |