| NPI | 1902290190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY S STOREY Office Manager 801-941-5025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5527707-3501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 286403-6004) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2015-03-25 |