Healthcare Provider Details

I. General information

NPI: 1407933328
Provider Name (Legal Business Name): WINDY RIDGE PSYCHOLOGICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 CY AVE SUITE 302
CASPER WY
82604
US

IV. Provider business mailing address

1607 CY AVE SUITE 302
CASPER WY
82604
US

V. Phone/Fax

Practice location:
  • Phone: 307-234-0500
  • Fax: 307-234-0500
Mailing address:
  • Phone: 307-234-0500
  • Fax: 307-234-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number274 PSYCHOLOGY
License Number StateWY

VIII. Authorized Official

Name: MRS. CHERYL ANN GODLEY
Title or Position: PRESIDENT
Credential: PHD
Phone: 307-234-0500