| Teton Behavior Therapy | |
|
480 S Cache St Jackson WY 83001-8222 | |
| (307) 734-6040 | |
| (307) 734-6040 |
| Full Name | Teton Behavior Therapy |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 480 S Cache St, Jackson, Wyoming |
| Authorized Official Name and Position | Jennifer Bradof (OWNER) |
| Authorized Official Contact | 3077346040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Teton Behavior Therapy Po Box 2299 Jackson WY 83001-2299 Ph: (307) 734-6040 | Teton Behavior Therapy 480 S Cache St Jackson WY 83001-8222 Ph: (307) 734-6040 |
| NPI Number | 1407230766 |
|---|---|
| Provider Enumeration Date | 07/16/2015 |
| Last Update Date | 07/16/2015 |
| Medicare PECOS PAC ID | 7416213699 |
|---|---|
| Medicare Enrollment ID | O20171102003605 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407230766 | NPI | - | NPPES |
| 137887200 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LCSW-837 (Wyoming) | Primary |
| Provider Name | Jennifer M Bradof |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275971442 PECOS PAC ID: 8325304504 Enrollment ID: I20171222001151 |
| Provider Name | Jamie R Lasden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033645825 PECOS PAC ID: 8022352327 Enrollment ID: I20181127001912 |
| Provider Name | Michael Tilden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932704459 PECOS PAC ID: 4183009590 Enrollment ID: I20220921003511 |
| Provider Name | Jean Abrams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003265521 PECOS PAC ID: 4981084472 Enrollment ID: I20230127001673 |
| Provider Name | Heather Franklin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497303853 PECOS PAC ID: 6709260714 Enrollment ID: I20230329003146 |
| Provider Name | Charlotte Alexander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265673388 PECOS PAC ID: 6608240874 Enrollment ID: I20230330001057 |
| Provider Name | Sarah W Caldwell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225399025 PECOS PAC ID: 9931573110 Enrollment ID: I20230330001638 |
| Provider Name | Hillary T Lavino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518513852 PECOS PAC ID: 5698140887 Enrollment ID: I20230330002136 |
| Provider Name | Elizabeth Martinez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235799172 PECOS PAC ID: 6204200496 Enrollment ID: I20230330002385 |
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