| NPI | 1558611970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES MCCUSKER Registered Agent 435-695-4421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 1160352501) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2012-09-13 |