| NPI | 1245636752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN EDWARD DAVIES Psychotherapist 435-757-5660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: UT 133085-6004) |
| Enumeration Date | 2014-11-11 |
| Last Update Date | 2014-11-11 |