| NPI | 1871325910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON NIZER Credentialing Specialist 307-885-9888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0800X Clinic/Center, Recovery Care |
| Enumeration Date | 2024-08-16 |
| Last Update Date | 2025-11-03 |