MEDICARE: SNOW DAY PSYCHIATRY LLC

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
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1851197610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNOW DAY PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	1621 CENTRAL AVE # 8211
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4531
Country	:	US
Telephone Number	:	73-872-0013
Fax Number	:	307-387-2004

Provider Business Practice Location Address
First Line	:	1621 CENTRAL AVE STE 8211
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-4531
Country	:	US
Telephone Number	:	73-872-0013
Fax Number	:	307-387-2004

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MARK LANDON MILLWOOD JR.
Credential	:	APRN
Telephone Number	:	901-496-8884

Provider Enumeration Date	:	02/21/2025
Last Update Date	:	02/26/2025

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