| NPI | 1487068979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY BRYSON JINDRA Mental Health Counselor 801-358-0967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QD1600X Clinic/Center Developmental Disabilities |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QM1100X Clinic/Center Military/U.S. Coast Guard Outpatient | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: UT 7025125-6004) | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2014-06-12 |