Provider Demographics
NPI:1477008183
Name:COMMUNITY MENTAL HEALTH CENTER OF WYOMING
Entity Type:Organization
Organization Name:COMMUNITY MENTAL HEALTH CENTER OF WYOMING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-272-9224
Mailing Address - Street 1:3928 ROAD 9
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82411-9731
Mailing Address - Country:US
Mailing Address - Phone:307-272-9224
Mailing Address - Fax:
Practice Address - Street 1:3928 ROAD 9
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WY
Practice Address - Zip Code:82411-9731
Practice Address - Country:US
Practice Address - Phone:307-272-9224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-860261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health