| NPI | 1205314754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA WILSON Billing 307-222-2013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2020-09-01 |