Healthcare Provider Details

I. General information

NPI: 1740407113
Provider Name (Legal Business Name): SWEETWATER COUNTY CHILD DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 HITCHING POST
GREEN RIVER WY
82935-5783
US

IV. Provider business mailing address

1715 HITCHING POST
GREEN RIVER WY
82935-5783
US

V. Phone/Fax

Practice location:
  • Phone: 307-875-0268
  • Fax: 307-875-3805
Mailing address:
  • Phone: 307-875-0268
  • Fax: 307-875-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateWY

VIII. Authorized Official

Name: MRS. LUCINDA KASPER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 307-875-0268