| NPI | 1265997746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY ERICKSON Clinical Director/ Owner 801-678-4198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2019-02-08 |