| NPI | 1487294252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARENA Z JACKSON Program Director 801-486-8143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 251B00000X Case Management | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2020-01-09 |