MEDICARE: CALM WATERS PSYCHIATRY, 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1790639573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALM WATERS PSYCHIATRY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 14666
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-4666
Country	:	US
Telephone Number	:	775-772-1102
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 PIONEER LN STE 10
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8175
Country	:	US
Telephone Number	:	775-772-1102
Fax Number	:

Authorized Official
Title or Position	:	PMHNP/OWNER
Name	:	THERESE HOOFT
Credential	:	DNP, MHS, PMHNP-BC
Telephone Number	:	775-772-1102

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	04/15/2026

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