| NPI | 1194226266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM K FULLER President/CEO/Clinical Director 435-631-9918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: WY 306) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2018-03-17 |