| Van Vleck House | |
|
510 S. Cache Dr. Jackson WY 83001-2631 | |
| (307) 733-6440 | |
| Not Available |
| Full Name | Van Vleck House |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 510 S. Cache Dr., Jackson, Wyoming |
| Authorized Official Name and Position | Cindy Knight (DIRECTOR) |
| Authorized Official Contact | 3077336440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Van Vleck House Po Box 2631 510 S. Cache Jackson WY 83001-2631 Ph: (307) 733-6440 | Van Vleck House 510 S. Cache Dr. Jackson WY 83001-2631 Ph: (307) 733-6440 |
| NPI Number | 1720288491 |
|---|---|
| Provider Enumeration Date | 07/20/2007 |
| Last Update Date | 07/20/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720288491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LMFT-045 (Wyoming) | Primary |
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