Organization
INNSAEI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN TUDSANDOS (BUSINESS MANAGER)
(385) 221-0200
Entity
Organization
Contact information
Practice address
264 W CENTER ST, OREM, UT 84057-4637
(801) 225-4027
Mailing address
264 W CENTER ST, OREM, UT 84057-4637
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
03/21/2022
Last updated
02/20/2023
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