| NPI | 1821297102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLJEAN BONGO Clinical Psychologist 307-760-1871 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 432) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2022-07-21 |