Provider Demographics
NPI:1619629912
Name:SILVER SAGE PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:SILVER SAGE PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANVLEET
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP, PMHNP-BC
Authorized Official - Phone:307-288-2329
Mailing Address - Street 1:724 FRONT ST STE 404
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3589
Mailing Address - Country:US
Mailing Address - Phone:307-288-2328
Mailing Address - Fax:
Practice Address - Street 1:724 FRONT ST STE 404
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3589
Practice Address - Country:US
Practice Address - Phone:307-288-2328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty