| NPI | 1407676596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY GREENBAUM Manager 307-690-3383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2024-11-26 |