| NPI | 1770177842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI A. DOUGHERTY Clinical Director 307-222-7952 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2021-03-15 |