| NPI | 1538462783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LOGAN Owner/Operator 307-426-4798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WY PHD-419) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CO 15431) | |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2023-10-27 |