| NPI | 1568721298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZA SANDERSON Clinical Director 435-640-3138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY 1149) |
| 251S00000X (Licence: WY 1149) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WY 1149) | |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2018-03-21 |