| NPI | 1245814458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY COOLEY Senior Director, Service Operations 307-459-6159 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2021-05-12 |