| NPI | 1972027332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS ALAN TUCKER Owner 801-979-0610 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 275986-3501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 5725100-6004) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 7096258-4405) | |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 7096258-8900) | |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2019-10-30 |