| NPI | 1033484118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY WENTZ Counselor 307-235-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY LPC817) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY LAT286) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2016-03-11 |