| NPI | 1851806434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE JO TOTH-HENDERSON Owner 307-258-1326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CT 2609) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2021-10-14 |