| NPI | 1669691499 |
|---|---|
| Doing Business As | LDS FAMILY SERVICES UT PROVO AGENCY |
| Entity Type | Organization |
| Authorized Contact | SHAWN A GILLIES Agency Director 801-422-7620 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 12208) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2008-06-06 |