| NPI | 1972644540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES LAWRENCE POULTON President 801-350-0117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: UT 114917-2501) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2010-12-17 |