| NPI | 1679330070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELENOA MOALA Program Director 801-403-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TF0000X Psychologist, Family | |
| 103TP0814X Psychologist, Psychoanalysis | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2024-03-06 |