| NPI | 1972854800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODIE LYNN WALLACE Owner 307-797-1726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW 800) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2012-10-02 |