| NPI | 1780968263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM FUNKE Director 435-703-8090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133NN1002X Nutritionist, Nutrition, Education |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 133N00000X Nutritionist | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2011-10-03 |