| NPI | 1205046711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINDY C MOREHEAD Insurance Credentialing/Billing Spe 435-695-2077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-06-24 |