| NPI | 1447601117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN GORDON Marriage And Family Therapist 435-215-3184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: UT 8017789-3902) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2016-06-23 |