| NPI | 1790289098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN WIET Owner 801-915-3698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: UT 371205-1106) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2018-03-21 |