Healthcare Provider Details

I. General information

NPI: 1396657268
Provider Name (Legal Business Name): MS. CARLENE DE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E 2ND AVE
CHEYENNE WY
82001-1408
US

IV. Provider business mailing address

304 E 2ND AVE
CHEYENNE WY
82001-1408
US

V. Phone/Fax

Practice location:
  • Phone: 307-631-0265
  • Fax:
Mailing address:
  • Phone: 307-631-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: