| NPI | 1215360425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLEEN M FULLER President 801-652-2720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 2004192501) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2019-04-18 |