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Organization

CLEAN CLINIC WYOMING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. LORENCE A HARMER (CEO)
(801) 946-4045
Entity
Organization

Contact information

Practice address
1918 THOMES AVE, CHEYENNE, WY 82001-3527
(928) 242-9929
Mailing address
63 E 11400 S # 275, SANDY, UT 84070-6705
(801) 946-4045

Taxonomy

Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary

Other

Enumeration date
06/01/2022
Last updated
02/17/2024
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