| NPI | 1780216507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN PARKE Program Director 435-610-1696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional | |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2020-02-10 |