| NPI | 1720590060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA LYNN GLEAVE Owner 801-830-8541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 2017-31336) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2017-10-26 |