DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: PROUD MENTAL HEALTH LLC

MEDICARE: PROUD MENTAL HEALTH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
2363LP0808XPsychiatric/Mental Health Nurse Practitioner
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1093661241
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROUD MENTAL HEALTH LLC
Provider Business Mailing Address
First Line : 1309 COFFEEN AVE # 19118
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-5777
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1309 COFFEEN AVE # 19118
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-5777
Country : US
Telephone Number : 657-229-5479
Fax Number :
Authorized Official
Title or Position : OWNER/CEO
Name : JONATHAN WAYNE SHAW
Credential : PMHNP
Telephone Number : 657-229-5479
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

Similar Medicare Providers

1881553063 — KRUNCHCONTACT LLC
Practice Location Address:
1309 COFFEEN AVE STE 1200
SHERIDAN, WY
82801-5777
Practice Phone: 201-685-9531
Practice Fax:
1386181782 — KELLY PAPESH CNP
Practice Location Address:
1309 COFFEEN AVE # 1200
SHERIDAN, WY
82801-5777
Practice Phone: 702-483-6000
Practice Fax: 949-703-8555
1316496706 — NICHOLAS HATCHER
Practice Location Address:
1309 COFFEEN AVE STE 1200
SHERIDAN, WY
82801-5777
Practice Phone: 888-680-7417
Practice Fax: 888-494-1717
1609318435 — JESSENIA OLIVO ARNP-BC
Practice Location Address:
1309 COFFEEN AVE STE 1200
SHERIDAN, WY
82801-5777
Practice Phone: 516-423-3234
Practice Fax:
1629549118 — SACHA JAMES APRN
Practice Location Address:
1309 COFFEEN AVE STE 1200
SHERIDAN, WY
82801-5777
Practice Phone: 813-695-6922
Practice Fax: 833-485-4679
1487212304 — DR. NICHOLA ANTOINETTE PATTON DNP, MBA, AGACNP-BC
Practice Location Address:
1309 COFFEEN AVE STE 12846
SHERIDAN, WY
82801-5777
Practice Phone: 888-603-8008
Practice Fax: 866-782-6597

Directions to “PROUD MENTAL HEALTH LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.