Organization
CLEAR CREEK COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADELAIDE WILSON (OWNER MEMBER)
(307) 337-8247
Entity
Organization
Contact information
Practice address
63 N BURRITT AVE, BUFFALO, WY 82834-1868
(307) 337-8247
Mailing address
PO BOX 69, BUFFALO, WY 82834-0069
(307) 337-8247
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
145
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136274700
—
WY
Enumeration date
08/12/2016
Last updated
08/12/2016
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