| NPI | 1407169907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES NUTTALL Owner 801-906-8780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2017-04-27 |