| NPI | 1699420828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH JAMES MEEKS Office Manager 435-621-1668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-02-16 |
| Last Update Date | 2022-02-16 |