Provider Demographics
NPI:1295211787
Name:NICOLE RUE, PSY.D., LLC
Entity Type:Organization
Organization Name:NICOLE RUE, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:307-690-2763
Mailing Address - Street 1:PO BOX 11891
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-1891
Mailing Address - Country:US
Mailing Address - Phone:307-690-2763
Mailing Address - Fax:
Practice Address - Street 1:1115 MAPLE WAY STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8567
Practice Address - Country:US
Practice Address - Phone:307-690-2763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY656261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)