| NPI | 1386776730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE REEDER Billing Lead 435-797-1346 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2018-06-08 |