| NPI | 1528182870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE J. JOHNSON Manager, Provider Enrollment 801-442-3156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2013-12-03 |