| NPI | 1235531344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARI DENE PETERSON Office Manager 801-466-9233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 115695 2501) |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2014-09-19 |