| NPI | 1295448256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA ROTH Owner / Counselor 307-751-5111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2023-01-04 |