| NPI | 1295177038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY CARL FELLER Owner 801-809-1049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7057775-3501) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-09-06 |