| NPI | 1912788357 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | BRENNAN DALE ATHERTON Clinical Psychologist 801-717-0405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2023-10-11 |