| NPI | 1285251967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER S. TEDMON-JONES Provider/Owner 307-200-9228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225600000X Dance Therapist |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-01-07 |