| Hope's Beacon | |
|
2617 E Lincolnway Ste G Cheyenne WY 82001-5671 | |
| (307) 514-1288 | |
| (307) 514-0979 |
| Full Name | Hope's Beacon |
|---|---|
| Speciality | Social Worker |
| Location | 2617 E Lincolnway Ste G, Cheyenne, Wyoming |
| Authorized Official Name and Position | Stephanie A. Mcmackin (PARTNER) |
| Authorized Official Contact | 3072231157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hope's Beacon 2617 E Lincolnway Ste G Cheyenne WY 82001-5671 Ph: (307) 514-1288 | Hope's Beacon 2617 E Lincolnway Ste G Cheyenne WY 82001-5671 Ph: (307) 514-1288 |
| NPI Number | 1467093666 |
|---|---|
| Provider Enumeration Date | 09/30/2019 |
| Last Update Date | 07/20/2022 |
| Certification Date | 07/20/2022 |
| Medicare PECOS PAC ID | 3476980673 |
|---|---|
| Medicare Enrollment ID | O20200228000769 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467093666 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Stephanie Ann Mcmackin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073919684 PECOS PAC ID: 5294162491 Enrollment ID: I20200228000902 |
| Provider Name | Kellie Bouldin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124482328 PECOS PAC ID: 9133565351 Enrollment ID: I20240311002237 |
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