| NPI | 1801352729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIANNE HAINES Owner 801-377-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 208000000X Pediatrics |
| 2080A0000X Pediatrics Adolescent Medicine | |
| 261QH0100X Clinic/Center Health Service | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 363LN0000X Nurse Practitioner Neonatal | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 364SF0001X Clinical Nurse Specialist Family Health | |
| 364SP0807X Clinical Nurse Specialist Psychiatric/Mental Health, Child & Adolescent | |
| Enumeration Date | 2019-02-15 |
| Last Update Date | 2020-08-28 |