Provider Demographics
NPI:1952468043
Name:RECTOR, PHILLIP KENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:KENT
Last Name:RECTOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:FORT WASHAKIE
Mailing Address - State:WY
Mailing Address - Zip Code:82514-0128
Mailing Address - Country:US
Mailing Address - Phone:307-332-7300
Mailing Address - Fax:307-332-2949
Practice Address - Street 1:BLACK COAL DRIVE
Practice Address - Street 2:BUILDING 29
Practice Address - City:FORT WASHAKIE
Practice Address - State:WY
Practice Address - Zip Code:82514
Practice Address - Country:US
Practice Address - Phone:307-332-7300
Practice Address - Fax:307-332-2949
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY334103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR62190Medicare UPIN
CACP7799Medicare ID - Type UnspecifiedMEDICARE PROVIDER #