Healthcare Provider Details

I. General information

NPI: 1720288491
Provider Name (Legal Business Name): TETON YOUTH AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S. CACHE DR.
JACKSON WY
83001-2631
US

IV. Provider business mailing address

PO BOX 2631 510 S. CACHE
JACKSON WY
83001-2631
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-6440
  • Fax:
Mailing address:
  • Phone: 307-733-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLMFT-045
License Number StateWY

VIII. Authorized Official

Name: MS. CINDY KNIGHT
Title or Position: DIRECTOR
Credential: MSW
Phone: 307-733-6440