| NPI | 1265976195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZ KOCIOLEK Executive Director 801-590-9557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: UT 178852-1205) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2016-12-12 |