| Clear Creek Company Llc | |
|
63 N Burritt Ave Buffalo WY 82834-1868 | |
| (307) 337-8247 | |
| Not Available |
| Full Name | Clear Creek Company Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 63 N Burritt Ave, Buffalo, Wyoming |
| Authorized Official Name and Position | Adelaide Wilson (OWNER MEMBER) |
| Authorized Official Contact | 3073378247 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clear Creek Company Llc Po Box 69 Buffalo WY 82834-0069 Ph: (307) 337-8247 | Clear Creek Company Llc 63 N Burritt Ave Buffalo WY 82834-1868 Ph: (307) 337-8247 |
| NPI Number | 1679027155 |
|---|---|
| Provider Enumeration Date | 08/12/2016 |
| Last Update Date | 08/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679027155 | NPI | - | NPPES |
| 136274700 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 145 (Wyoming) | Primary |
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