| NPI | 1972133783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY JENSON Manager 801-556-1977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2023-03-20 |