| NPI | 1487427340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE GOODMAN President/Owner 801-425-2831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2023-11-06 |