| NPI | 1053771287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELA FRANCISCA PETERSON Owner 307-413-6528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY 1071) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WY 136) |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2016-03-01 |