| NPI | 1750806519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY ERICKSON Therapist 801-678-4198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 10471569-0160) |
| Enumeration Date | 2017-08-13 |
| Last Update Date | 2017-08-13 |