| NPI | 1245786110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER SUSAN CRUICKSHANK Owner 307-215-1204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WY LPC-1625) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2021-03-23 |