| NPI | 1407236060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA ERICKSON Proprietor, Lpc 307-250-7522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WY LPC-1145) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY LPC-1145) |
| 101YP2500X Counselor, Professional (Licence: WY LPC-1145) | |
| 251S00000X (Licence: WY LPC-1145) | |
| 1041C0700X Social Worker, Clinical (Licence: WY PCSW-605) | |
| 104100000X Social Worker (Licence: WY PCSW-605) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2015-07-30 |