| NPI | 1811058076 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY J. RECK Office Manager 435-797-2032 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 5805022-2501) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-08-22 |