Organization
BIG HORN BASIS MENTAL HEALTH GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GIBSON B CONDIE PH.D (PRESIDENT)
(307) 754-3860
Entity
Organization
Contact information
Practice address
1054 VALI RD, POWELL, WY 82435-9259
(307) 754-3860
Mailing address
1054 VALI RD, POWELL, WY 82435-9259
(307) 754-3860
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
#SP04
WY
Other
Enumeration date
04/19/2007
Last updated
08/22/2020
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