| NPI | 1336682145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY WILLARD Owner 801-550-9057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: UT 3582863501) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2016-11-28 |