| NPI | 1225693872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAYLOR LADD Administrative Assistant 307-660-7789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2019-05-08 |