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NPI Code Detail

MEDICARE: THOMAS BOUGSTY PH.D.

MEDICARE: THOMAS BOUGSTY PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistWY134WY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1138818OTHERWYMHN
2178429OTHERWYVALUE OPTIONS
3313242OTHERWYBS OF WY

General Provider Information

NPI Number : 1801998398
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS BOUGSTY PH.D.
Provider Business Mailing Address
First Line : 2321 DUNN AVE
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-3214
Country : US
Telephone Number : 307-634-1480
Fax Number :
Provider Business Practice Location Address
First Line : 2321 DUNN AVE
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-3214
Country : US
Telephone Number : 307-634-1480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2006
Last Update Date : 01/13/2013

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Directions to “ THOMAS BOUGSTY PH.D.” Practice Location

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