Healthcare Provider Details

I. General information

NPI: 1780735357
Provider Name (Legal Business Name): ROLAND HART PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BLACK COAL DR.
FT. WASHAKIE WY
82514-0128
US

IV. Provider business mailing address

20 TIMBERLINE TRL
LANDER WY
82520-9634
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-7300
  • Fax: 307-332-3949
Mailing address:
  • Phone: 307-332-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-227
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: