| NPI | 1275824997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN RENAE PHILLIPS Therapist 307-686-0669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: WY LPC1150) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2011-04-28 |