Provider Demographics
NPI:1164034492
Name:SKYLINE MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:SKYLINE MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-784
Authorized Official - Phone:307-350-8759
Mailing Address - Street 1:1471 DEWAR DR STE 232
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5885
Mailing Address - Country:US
Mailing Address - Phone:307-350-8759
Mailing Address - Fax:307-215-8337
Practice Address - Street 1:1471 DEWAR DR STE 232
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5885
Practice Address - Country:US
Practice Address - Phone:307-350-8759
Practice Address - Fax:307-215-8337
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKYLINE MENTAL HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-18
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1972734283OtherBLUE CROSS BLUE SHIELD WYOMING