| NPI | 1790484889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMAICA SANTOS MOULTON Owner 307-254-5048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2024-05-28 |