| NPI | 1093014276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY HEENAN Co Owner 307-265-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WY LPC 1059) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: WY LPC 1073) |
| 251S00000X Community/Behavioral Health (Licence: WY LMFT 139) | |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2011-10-21 |