| Prospera Healthcare Wyoming Llc | |
|
312 W 2nd St # 2037 Casper WY 82601-2412 | |
| (972) 900-2488 | |
| (972) 600-2835 |
| Full Name | Prospera Healthcare Wyoming Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 312 W 2nd St # 2037, Casper, Wyoming |
| Authorized Official Name and Position | Chris Tillotson (CEO) |
| Authorized Official Contact | 9729002488 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prospera Healthcare Wyoming Llc 312 W 2nd St # 2037 Casper WY 82601-2412 Ph: (972) 900-2488 | Prospera Healthcare Wyoming Llc 312 W 2nd St # 2037 Casper WY 82601-2412 Ph: (972) 900-2488 |
| NPI Number | 1215671185 |
|---|---|
| Provider Enumeration Date | 04/26/2022 |
| Last Update Date | 04/26/2022 |
| Certification Date | 04/26/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215671185 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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