| NPI | 1891099545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIPP L DANA Executive Director 307-885-9883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: WY LPC-550) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WY LAT-220) | |
| 291U00000X Clinical Medical Laboratory | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2022-06-14 |