| NPI | 1750940896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLDEN D GLENN Owner 435-774-6533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2019-11-18 |