| NPI | 1235279498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW V. KUNZ Program Manager 307-432-0494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 163W00000X Registered Nurse |
| 251C00000X Day Training, Developmentally Disabled Services | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-08-22 |