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General NPI Number Information
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NPI Number | 1417835588
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Entity Type | Organization
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Legal Business Name | MANTRACARE CORPORATION
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 30 N GOULD ST
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 332-331-8626
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N GOULD ST # 40683
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. HIMANSHU JAIN
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Credential |
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Telephone | 332-331-8626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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