Healthcare Provider Details

I. General information

NPI: 1326341827
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF WYOMING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 BENT AVE
CHEYENNE WY
82001-2959
US

IV. Provider business mailing address

PO BOX 1026
TORRINGTON WY
82240-1026
US

V. Phone/Fax

Practice location:
  • Phone: 307-637-0554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7552A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number1
License Number StateWY

VIII. Authorized Official

Name: MR. ROBERT C MAYOR
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 307-532-4197