| Lupine Mental Health And Integrative Psychiatry Llc | |
|
125 E Pearl Ave Ste 207 Jackson WY 83001-8599 | |
| (307) 203-2656 | |
| Not Available |
| Full Name | Lupine Mental Health And Integrative Psychiatry Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 125 E Pearl Ave Ste 207, Jackson, Wyoming |
| Authorized Official Name and Position | Susan G Wolff (PSYCHIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 3072032656 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lupine Mental Health And Integrative Psychiatry Llc Po Box 1132 Jackson WY 83001-1132 Ph: () - | Lupine Mental Health And Integrative Psychiatry Llc 125 E Pearl Ave Ste 207 Jackson WY 83001-8599 Ph: (307) 203-2656 |
| NPI Number | 1871103127 |
|---|---|
| Provider Enumeration Date | 08/02/2020 |
| Last Update Date | 08/02/2020 |
| Certification Date | 08/02/2020 |
| Medicare PECOS PAC ID | 8426468737 |
|---|---|
| Medicare Enrollment ID | O20201027002432 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871103127 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Susan Gail Wolff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558912477 PECOS PAC ID: 8729068606 Enrollment ID: I20191108002710 |
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