| NPI | 1912441759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRICIA SULLIVANT Owner 801-541-9566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 86376063501) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2016-12-13 |