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NPI Code Detail

MEDICARE: MEDICAL PSYCHOTHERAPY PC

MEDICARE: MEDICAL PSYCHOTHERAPY PC
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
12084P0800XPsychiatry PhysicianM-8621ID

General Provider Information

NPI Number : 1417904095
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL PSYCHOTHERAPY PC
Provider Business Mailing Address
First Line : PO BOX 589
Second Line :
City : JACKSON
State : WY
Zip : 83001-0589
Country : US
Telephone Number : 307-201-1254
Fax Number :
Provider Business Practice Location Address
First Line : 140 E BROADWAY AVE
Second Line :
City : JACKSON
State : WY
Zip : 83001-8632
Country : US
Telephone Number : 307-201-1254
Fax Number :
Authorized Official
Title or Position : OWNER/ PHYSICIAN
Name : DR. PHILIP W GIRLING
Credential : M.D.
Telephone Number : 307-201-1254
Provider Enumeration Date : 05/28/2006
Last Update Date : 04/07/2014

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