| NPI | 1932699642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINDI WEBER Credentialing / Contract Manager 801-562-4484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2018-05-17 |