| NPI | 1689292658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAMONE MARTINEZ CEO 801-471-1027 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2020-07-07 |