| NPI | 1245729417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER STARK Owner 801-518-9362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 8598755-6004) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: UT 6153954-3902) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2018-05-03 |