| NPI | 1255415907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER FILBY Billing/Credentialing Specialist 435-752-0750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 1141192501) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2026-05-06 |