| NPI | 1265592083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MICHAEL FENSTERMACHER President 801-201-3139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: UT 5075655-2501) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-22 |