| NPI | 1790229185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN LEAVITT Owner/ Clinical Director 801-623-0125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: UT 34485) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: UT 34485) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2016-12-05 |