| NPI | 1568510550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL M. RICKS Clinical Director 801-955-9110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: UT 12358) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 17474) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2011-06-20 |