| Wyoming Path Behavioral Health, Llc | |
|
431 Main St Lander WY 82520-3145 | |
| (307) 857-3111 | |
| Not Available |
| Full Name | Wyoming Path Behavioral Health, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 431 Main St, Lander, Wyoming |
| Authorized Official Name and Position | Stephanie Peterson (OPERATOR) |
| Authorized Official Contact | 3078403594 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wyoming Path Behavioral Health, Llc 431 Main St Lander WY 82520-3145 Ph: (307) 857-3111 | Wyoming Path Behavioral Health, Llc 431 Main St Lander WY 82520-3145 Ph: (307) 857-3111 |
| NPI Number | 1851962997 |
|---|---|
| Provider Enumeration Date | 07/09/2021 |
| Last Update Date | 08/15/2024 |
| Certification Date | 08/15/2024 |
| Medicare PECOS PAC ID | 3274916812 |
|---|---|
| Medicare Enrollment ID | O20220816000189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851962997 | NPI | - | NPPES |
| Provider Name | Trent L House |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619234044 PECOS PAC ID: 3678729084 Enrollment ID: I20120816000885 |
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