Provider Demographics
NPI:1679199897
Name:WYOMING TRAUMA TREATMENT CENTER
Entity Type:Organization
Organization Name:WYOMING TRAUMA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MOSHER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:307-259-8117
Mailing Address - Street 1:800 WERNER CT STE 258
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1324
Mailing Address - Country:US
Mailing Address - Phone:307-259-8117
Mailing Address - Fax:605-443-8880
Practice Address - Street 1:800 WERNER CT STE 258
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1324
Practice Address - Country:US
Practice Address - Phone:307-259-8117
Practice Address - Fax:605-443-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)