| NPI | 1962888610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE BALLEW Therapist 801-787-7735 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 8650132-3501) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2015-08-05 |