| NPI | 1295207231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA PORTER Clinical Director 801-851-5504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2018-12-31 |