| Big Horn Psychological Services Lc | |
|
339 W Loucks St Sheridan WY 82801-4121 | |
| (307) 675-1805 | |
| Not Available |
| Full Name | Big Horn Psychological Services Lc |
|---|---|
| Speciality | Psychologist |
| Location | 339 W Loucks St, Sheridan, Wyoming |
| Authorized Official Name and Position | Alicia A Clark (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 3076751805 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Big Horn Psychological Services Lc Po Box 1035 Sheridan WY 82801-1035 Ph: (307) 675-1805 | Big Horn Psychological Services Lc 339 W Loucks St Sheridan WY 82801-4121 Ph: (307) 675-1805 |
| NPI Number | 1336473859 |
|---|---|
| Provider Enumeration Date | 09/30/2009 |
| Last Update Date | 07/08/2024 |
| Certification Date | 07/08/2024 |
| Medicare PECOS PAC ID | 3375788839 |
|---|---|
| Medicare Enrollment ID | O20130404000150 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336473859 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Alicia A Clark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134216690 PECOS PAC ID: 5799888061 Enrollment ID: I20070307000537 |
| Provider Name | Jeffrey P Clark |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063403822 PECOS PAC ID: 0941303499 Enrollment ID: I20070321000393 |
| Provider Name | Layne Katheryne Holler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548635493 PECOS PAC ID: 6901102961 Enrollment ID: I20160317000600 |
| Provider Name | Carrie J Prado |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679924559 PECOS PAC ID: 2567861156 Enrollment ID: I20211001002580 |
| Provider Name | Lawrence Kevin Woodrow |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528430857 PECOS PAC ID: 4587051321 Enrollment ID: I20220427000022 |
| Provider Name | Lisa Jo Plett Kutz |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1790093169 PECOS PAC ID: 5496198822 Enrollment ID: I20240213001358 |
| Provider Name | Kathy Ruth Tiffany |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578894960 PECOS PAC ID: 6507201217 Enrollment ID: I20240304001173 |
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