| NPI | 1639547193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER TAD CLARK President 307-630-3466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WY 1198) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-14 |