| NPI | 1982083440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY FEHLBERG Director 435-901-0759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 5291247-2501) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2024-02-06 |