Provider Demographics
NPI:1558731885
Name:COLLABORATIVE CONNECTIONS
Entity Type:Organization
Organization Name:COLLABORATIVE CONNECTIONS
Other - Org Name:FAMILIES FIRST WYOMING
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:J D
Authorized Official - Phone:307-421-7038
Mailing Address - Street 1:109 E 17TH ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4543
Mailing Address - Country:US
Mailing Address - Phone:307-459-1712
Mailing Address - Fax:
Practice Address - Street 1:109 E 17TH ST
Practice Address - Street 2:SUITE 213
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4543
Practice Address - Country:US
Practice Address - Phone:307-459-1712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health