Organization
SHOSHONE & ARAPAHO TRIBAL SUBSTANCE ABUSE COURT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUNNY RAE GOGGLES (COORDINATOR)
(307) 335-8374
Entity
Organization
Contact information
Practice address
215 ETHETE RD, FORT WASHAKIE, WY 82514
(307) 335-8374
(307) 335-8299
Mailing address
PO BOX 1561, 215 ETHETE ROAD, FORT WASHAKIE, WY 82514-1561
(307) 335-8374
(307) 335-8299
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
04/02/2010
Last updated
04/02/2010
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