Provider Demographics
NPI:1083370258
Name:WYOMING PSYCHIATRY & CONSULTATION LLC
Entity Type:Organization
Organization Name:WYOMING PSYCHIATRY & CONSULTATION LLC
Other - Org Name:CORDILLERA MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:CUMMINGS
Authorized Official - Last Name:RORK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-264-2423
Mailing Address - Street 1:2862 ARDON LN
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3900
Mailing Address - Country:US
Mailing Address - Phone:307-690-0263
Mailing Address - Fax:
Practice Address - Street 1:2862 ARDON LN
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-3900
Practice Address - Country:US
Practice Address - Phone:307-690-0263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty