| NPI | 1386177681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY BLOOMER Manager 435-749-9944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2017-04-04 |