| NPI | 1811360936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAX AH QUIN Manager 801-830-2889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: UT 5847195-6004) |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2015-11-11 |