| NPI | 1356620579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA I GIBSON President 307-277-6132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WY 7660A) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WY 447) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2011-10-04 |