NPI Code Detail JSON Logo

1588067037 NPI number — WYOMING WELLNESS LLP

NPI Number: 1588067037
Health Care Provider/Practitioner: WYOMING WELLNESS LLP

Information about “1588067037” NPI (WYOMING WELLNESS LLP) exists in 1588067037 in HTML format HTML  |  1588067037 in plain Text format TXT  |  1588067037 in PDF (Portable Document Format) PDF  |  1588067037 in an XML format XML  formats.

NPI Number : 1588067037 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588067037",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WYOMING WELLNESS LLP",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "518 MONTCLAIR DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHEYENNE",
    "MailingAddressStateName": "WY",
    "MailingAddressPostalCode": "82009-2717",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-631-4912",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "112 E. BRIDGE",
    "SecondLinePracticeLocationAddress": "SUITE G",
    "PracticeLocationAddressCityName": "SARATOGA",
    "PracticeLocationAddressStateName": "WY",
    "PracticeLocationAddressPostalCode": "82331",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "307-631-4912",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/29/2014",
    "LastUpdateDate": "09/29/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JUNKIN",
    "AuthorizedOfficialFirstName": "CHARLES",
    "AuthorizedOfficialMiddleName": "E",
    "AuthorizedOfficialTitle": "GENERAL PARTNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MA, LPC",
    "AuthorizedOfficialTelephoneNumber": "307-631-4912",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": "1122",
        "LicenseNumberStateCode": "WY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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