| NPI | 1760217707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLIN JACKSON Manager 801-824-2421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-09-06 |
| Last Update Date | 2024-09-25 |