| NPI | 1932578911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE A PELLETIER President 435-512-1113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS017889) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2015-09-18 |