| NPI | 1700686557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB RUSSELL MOSS Member 801-867-5838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2025-03-19 |
| Last Update Date | 2025-03-19 |