Provider Demographics
NPI:1417904095
Name:MEDICAL PSYCHOTHERAPY PC
Entity Type:Organization
Organization Name:MEDICAL PSYCHOTHERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:GIRLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-201-1254
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-0589
Mailing Address - Country:US
Mailing Address - Phone:307-201-1254
Mailing Address - Fax:
Practice Address - Street 1:140 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8632
Practice Address - Country:US
Practice Address - Phone:307-201-1254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-86212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty