| NPI | 1619021912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY BUCKINGHAM VP Of It And Compliance 307-672-0475 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2023-04-01 |