| NPI | 1811422611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRI K LAKE Owner 801-520-3490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2017-04-29 |
| Last Update Date | 2017-05-01 |