| NPI | 1780459016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANAEL WESLEY RIDGE Owner 801-448-8699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-11-16 |
| Last Update Date | 2023-11-24 |