| NPI | 1932916756 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMANTHA STEWART Owner 307-887-0139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-12-16 |
| Last Update Date | 2024-12-16 |