| NPI | 1689049884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA JEAN CANNON Owner/President 307-851-9736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY 1214) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY 1214) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |