| NPI | 1598067480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE MAX HANCOCK Psychologist 435-750-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 74537142501) |
| Enumeration Date | 2010-11-27 |
| Last Update Date | 2010-11-27 |