| NPI | 1346883634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL STILES RANDAK Owner/Operator 801-450-0199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-10-20 |
| Last Update Date | 2019-10-20 |