Provider Demographics
NPI:1295296127
Name:PSYCHIATRY ASSOCIATES OF WYOMING
Entity type:Organization
Organization Name:PSYCHIATRY ASSOCIATES OF WYOMING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOGONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-710-2373
Mailing Address - Street 1:100 E EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-4511
Mailing Address - Country:US
Mailing Address - Phone:307-333-1123
Mailing Address - Fax:307-215-1187
Practice Address - Street 1:100 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-4511
Practice Address - Country:US
Practice Address - Phone:307-333-1123
Practice Address - Fax:307-215-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty