| NPI | 1609016153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANI FAEZ Clinical Supervisor 307-733-3908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 104100000X Social Worker (Licence: WY 384) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2022-03-22 |