| NPI | 1538638705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEN MAKIN Owner 801-900-1353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2018-11-17 |
| Last Update Date | 2019-06-11 |