| NPI | 1992124473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAQUELINE PACK Owner 801-628-6344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 3158913501) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2014-04-10 |