| NPI | 1447897871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY JANE NELSON Owner/Clinical Director 801-701-0348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2023-06-27 |