| NPI | 1063894632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE BURKLAND Executive Director 307-733-9098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: WY PPC-892) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2015-06-19 |