Organization
UNACCOMPANIED STUDENT INITIATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA MOORE (EXECUTIVE DIRECTOR)
(307) 220-2391
Entity
Organization
Contact information
Practice address
910 W FOX FARM RD, CHEYENNE, WY 82007-2674
(307) 220-2391
Mailing address
PO BOX 22103, CHEYENNE, WY 82003-2030
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
01/28/2020
Last updated
01/28/2020
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