| NPI | 1740074368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MCKENZIE FREDERICK Owner 307-462-3569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2025-04-08 |
| Last Update Date | 2025-07-20 |