| NPI | 1487038006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCIE D GRAY Owner/Operator 435-218-2414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 6656303-6006) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 266415-3501) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2016-05-16 |