Healthcare Provider Details

I. General information

NPI: 1295220242
Provider Name (Legal Business Name): FRONTIER BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 KING BLVD STE 313
CASPER WY
82604-3169
US

IV. Provider business mailing address

2435 KING BLVD STE 313
CASPER WY
82604-3169
US

V. Phone/Fax

Practice location:
  • Phone: 307-462-4876
  • Fax: 307-337-3492
Mailing address:
  • Phone: 307-462-4876
  • Fax: 307-337-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27393.1195
License Number StateWY

VIII. Authorized Official

Name: ANGELA NEFF
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: APRN, PMHNP-BC
Phone: 307-554-0423