| NPI | 1467799825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD HYDO Registered Agent 801-433-8149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 12W76898) |
| Enumeration Date | 2013-01-05 |
| Last Update Date | 2013-01-05 |