| NPI | 1356993570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES DAVID SKINNER Owner 307-426-4884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2019-07-21 |