| NPI | 1447673082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL RALEY MA RALEY Clinician 307-751-3769 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WY 1076) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY 1076) |
| 101YP2500X Counselor, Professional (Licence: WY 1076) | |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2014-02-03 |