| NPI | 1669926556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER KOSTIAL Owner/Operator 801-635-9580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: WA 60564652) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2016-08-08 |