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General NPI Number Information
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NPI Number | 1851624662
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Entity Type | Organization
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Legal Business Name | PARK RIDGE BEHAVIORAL HEALTHCARE, LLC
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 940 E 3RD ST STE 104
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City | CASPER
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State | WY
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Zip | 82601-3200
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Country | US
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Telephone | 307-462-4876
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Fax |
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Provider Business Mailing Address
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Address Line | 301 THELMA DR STE 226
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City | CASPER
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State | WY
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Zip | 82609
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Country | US
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Telephone | 405-412-5468
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRANDON WARDELL
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Credential | DBH, MAMFT, NCC, LPC
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Telephone | 405-412-5468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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