| NPI | 1538948005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHADRICK WYATT TILLOTSON President, CEO 801-404-9662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2023-11-27 |