Organization
BIG HORN BASIN MENTAL HEALTH GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GIBSON B. CONDIE PH.D. (PSYCHOLOGIST)
(307) 754-3860
Entity
Organization
Contact information
Practice address
1054 VALI RD, POWELL, WY 82435-9259
(307) 754-3860
Mailing address
1054 VALI RD, POWELL, WY 82435-9259
(307) 754-3860
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
SP03
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124068400
—
WY
Enumeration date
05/15/2007
Last updated
10/17/2014
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