| NPI | 1780712380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON NIZER Credentialing Specialist 307-885-9888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 291U00000X Clinical Medical Laboratory | |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2025-11-03 |