Provider Demographics
NPI:1235887902
Name:LISA MCDUFFIE PSYCHIATRY LLC
Entity Type:Organization
Organization Name:LISA MCDUFFIE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDUFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-673-0126
Mailing Address - Street 1:PO BOX 2417
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-2417
Mailing Address - Country:US
Mailing Address - Phone:307-638-0300
Mailing Address - Fax:307-638-0394
Practice Address - Street 1:909 LONG DR STE A
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3282
Practice Address - Country:US
Practice Address - Phone:307-673-0126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty