| NPI | 1689979361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE S HURICH Member 307-685-5288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WY LPC 1007) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2011-01-11 |