| NPI | 1720456981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGIE EVANS Bo 801-766-6604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: UT 14178) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2022-11-02 |