Provider Demographics
NPI:1295818870
Name:WYOMING BEHAVIORAL INSTITUTE
Entity Type:Organization
Organization Name:WYOMING BEHAVIORAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JULETTE
Authorized Official - Last Name:DOLL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-682-0442
Mailing Address - Street 1:2521 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4126
Mailing Address - Country:US
Mailing Address - Phone:307-237-7444
Mailing Address - Fax:307-472-2297
Practice Address - Street 1:518 N US HIGHWAY 14-16
Practice Address - Street 2:UNIT D
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3305
Practice Address - Country:US
Practice Address - Phone:307-682-0442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital