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Organization

TBT, LLC

Active
Other names
Teton Behavior Therapy
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER BRADOF LCSW (OWNER)
(307) 734-6040
Entity
Organization

Contact information

Practice address
480 S CACHE ST, JACKSON, WY 83001-8222
(307) 734-6040
(307) 734-6040
Mailing address
PO BOX 2299, JACKSON, WY 83001-2299
(307) 734-6040
(307) 734-6040

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LCSW-837
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
137887200
WY
Enumeration date
07/16/2015
Last updated
07/16/2015
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