| NPI | 1033544150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN L BERTILSON Owner 307-760-5450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW606) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2013-09-09 |