| NPI | 1417659186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY MANGNALL Licensed Psychologist 801-839-5360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2024-11-20 |