Provider Demographics
NPI:1922596196
Name:SNOWY RANGE CONSULTING, LLC
Entity Type:Organization
Organization Name:SNOWY RANGE CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-745-5414
Mailing Address - Street 1:526 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5106
Mailing Address - Country:US
Mailing Address - Phone:307-745-5414
Mailing Address - Fax:307-745-5138
Practice Address - Street 1:526 REGENCY DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5106
Practice Address - Country:US
Practice Address - Phone:307-745-5414
Practice Address - Fax:307-745-5138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY199103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115175Medicaid