| NPI | 1528458619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WINNIE MARIE PICKETT Owner/Operator 801-358-4463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 11517) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2015-01-28 |