Provider Demographics
NPI:1477326973
Name:WYONE MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:WYONE MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED INDEPENDENT MENTAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:R
Authorized Official - Last Name:STOTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:307-677-1618
Mailing Address - Street 1:124 W 25TH ST STE B4
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-4473
Mailing Address - Country:US
Mailing Address - Phone:308-627-9076
Mailing Address - Fax:
Practice Address - Street 1:124 W 25TH ST STE B4
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4473
Practice Address - Country:US
Practice Address - Phone:308-627-9076
Practice Address - Fax:308-455-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty