MEDICARE: PARK RIDGE BEHAVIORAL HEALTHCARE, 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	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851624662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK RIDGE BEHAVIORAL HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	301 THELMA DR STE 226
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609
Country	:	US
Telephone Number	:	405-412-5468
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 E 3RD ST STE 104
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-3200
Country	:	US
Telephone Number	:	307-462-4876
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRANDON WARDELL
Credential	:	DBH, MAMFT, NCC, LPC
Telephone Number	:	405-412-5468

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	11/13/2024

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Directions to “PARK RIDGE BEHAVIORAL HEALTHCARE, LLC ” Practice Location

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