| NPI | 1659175966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKOLAI MANEK CEO 307-466-7772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2025-04-03 |
| Last Update Date | 2025-04-24 |