Provider Demographics
NPI:1144399056
Name:SINK, JOHN R (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SINK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7418 LEGACY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-8350
Mailing Address - Country:US
Mailing Address - Phone:307-287-7787
Mailing Address - Fax:307-256-0203
Practice Address - Street 1:1700 WESTLAND RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3322
Practice Address - Country:US
Practice Address - Phone:307-287-7787
Practice Address - Fax:307-256-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY361103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313867OtherBLUE CROSS & BLUE SHIELD
WY119968400Medicaid