| NPI | 1790152940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY YOUNG BULLOCK Owner 801-389-9521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 7510289-2501) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2024-04-17 |