Provider Demographics
NPI:1942458195
Name:PERSONAL FRONTIERS, INC.
Entity Type:Organization
Organization Name:PERSONAL FRONTIERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BERTONCELJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-686-1189
Mailing Address - Street 1:PO BOX 754
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-0754
Mailing Address - Country:US
Mailing Address - Phone:307-686-1189
Mailing Address - Fax:307-682-8649
Practice Address - Street 1:310 S MILLER AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3944
Practice Address - Country:US
Practice Address - Phone:307-686-1189
Practice Address - Fax:307-682-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health