| NPI | 1942788237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN BRYCE BENNETT Owner 801-857-0867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2018-07-30 |