| NPI | 1366860777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARIEL GONZALES Owner 801-746-7190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 8566732-0162) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2014-07-02 |