| NPI | 1205291739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE EVANS Bo 801-766-6604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 31810) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 17567) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2016-10-12 |