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General NPI Number Information
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NPI Number | 1477008183
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Entity Type | Organization
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Legal Business Name | COMMUNITY MENTAL HEALTH CENTER OF WYOMING
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 3928 ROAD 9
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City | BURLINGTON
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State | WY
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Zip | 82411-9731
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Country | US
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Telephone | 307-272-9224
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Fax |
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Provider Business Mailing Address
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Address Line | 3928 ROAD 9
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City | BURLINGTON
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State | WY
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Zip | 82411-9731
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Country | US
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Telephone | 307-272-9224
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MATTHEW MCNIVEN
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Credential |
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Telephone | 307-272-9224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | LPC-860
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | LPC-860
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License Number State | WY
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