| NPI | 1720140114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANNINE RUSHTON-FOWLER Contracting Director 801-587-6336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2015-05-28 |