| NPI | 1790046415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROCK RICHARD GREEK Manager 307-432-2712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WY LCSW-592) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2012-05-30 |