| Mary Jo Jeffres Phd, Llc | |
|
103 N 5th St E Riverton WY 82501-4402 | |
| (307) 463-0890 | |
| (307) 463-0891 |
| Full Name | Mary Jo Jeffres Phd, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 103 N 5th St E, Riverton, Wyoming |
| Authorized Official Name and Position | Mary Jo Jeffres (OWNER) |
| Authorized Official Contact | 3074630890 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Jo Jeffres Phd, Llc 103 N 5th St E Riverton WY 82501-4402 Ph: (307) 463-0890 | Mary Jo Jeffres Phd, Llc 103 N 5th St E Riverton WY 82501-4402 Ph: (307) 463-0890 |
| NPI Number | 1962563361 |
|---|---|
| Provider Enumeration Date | 12/12/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 1759488380 |
|---|---|
| Medicare Enrollment ID | O20130528000127 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962563361 | NPI | - | NPPES |
| 121869700 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 421 (Wyoming) | Primary |
| Provider Name | Mary Jo Jeffres |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1629013784 PECOS PAC ID: 6103854955 Enrollment ID: I20051117000306 |
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