| NPI | 1376279059 |
|---|---|
| Other Name | PART |
| Entity Type | Organization |
| Authorized Contact | ERIN PETERSEN Provider Enrollment Specialist 307-432-3664 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2025-09-04 |