| NPI | 1578248118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE NICKS-IRVINE Sole Member 307-429-0644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2023-06-20 |