| NPI | 1164794434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY COSTLEY Director / Owner 801-263-1056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336I0012X Pharmacy, Institutional Pharmacy |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2020-08-03 |