| NPI | 1790482495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILEE JACKSON Owner 801-896-3260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2023-05-16 |