| NPI | 1619465838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN K ELLIS Clinical Social Worker 307-320-3082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: WY LCSW-1028) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2018-04-23 |