Healthcare Provider Details

I. General information

NPI: 1205137163
Provider Name (Legal Business Name): PEACEFUL FAMILIES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 E 18TH ST
CHEYENNE WY
82001-4617
US

IV. Provider business mailing address

507 E 18TH ST
CHEYENNE WY
82001-4617
US

V. Phone/Fax

Practice location:
  • Phone: 307-637-7906
  • Fax: 307-635-3965
Mailing address:
  • Phone: 307-637-7906
  • Fax: 307-635-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number267
License Number StateWY

VIII. Authorized Official

Name: MARY ELLEN STERNITZKE
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 307-637-7906