| Tessa Matzen, Lcsw Llc | |
|
121 E Grand Ave Ste 209 Laramie WY 82070-3652 | |
| (307) 761-4988 | |
| Not Available |
| Full Name | Tessa Matzen, Lcsw Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 121 E Grand Ave Ste 209, Laramie, Wyoming |
| Authorized Official Name and Position | Tessa Matzen (CEO) |
| Authorized Official Contact | 3077214988 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tessa Matzen, Lcsw Llc Po Box 982 Laramie WY 82073-0982 Ph: (307) 761-4988 | Tessa Matzen, Lcsw Llc 121 E Grand Ave Ste 209 Laramie WY 82070-3652 Ph: (307) 761-4988 |
| NPI Number | 1891377164 |
|---|---|
| Provider Enumeration Date | 04/26/2021 |
| Last Update Date | 04/26/2021 |
| Certification Date | 04/26/2021 |
| Medicare PECOS PAC ID | 2466851845 |
|---|---|
| Medicare Enrollment ID | O20210604002714 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891377164 | NPI | - | NPPES |
| 1447792593 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Tessa Matzen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447792593 PECOS PAC ID: 8527318856 Enrollment ID: I20180907001847 |
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