Organization
REGION V BOCES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MAURICE KEITH MADER M.S.W./L.C.S.W. (SCHOOL AND CLINICAL SOCIAL WORKER)
(307) 733-8210
Entity
Organization
Contact information
Practice address
3850 NORTH WILDERNESS DRIVE, WILSON, WY 83014-0240
(307) 733-8210
(307) 733-8462
Mailing address
PO BOX 240, WILSON, WY 83014-0240
(307) 733-8210
(307) 733-8462
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
LCSW-291
WY
Other
Enumeration date
06/19/2012
Last updated
06/19/2012
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