| NPI | 1982476370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LOGAN Owner/Operator 307-426-4797 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 251S00000X Community/Behavioral Health | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2023-10-27 |
| Last Update Date | 2023-11-02 |