Organization
ADONAI MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN P WALLA MHNP (NURSE PRACTITIONER)
(307) 685-8255
Entity
Organization
Contact information
Practice address
707 W 8TH ST, GILLETTE, WY 82716-4108
(307) 685-8255
(888) 852-8319
Mailing address
707 W 8TH ST, GILLETTE, WY 82716-4108
(307) 685-8255
(888) 852-8319
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
29650.1122
WY
Other
Enumeration date
09/16/2013
Last updated
10/24/2014
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