| NPI | 1164095022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FORREST JIM WOLVERTON Owner 435-767-8840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2021-11-16 |