Provider Demographics
NPI:1649795907
Name:COWBOY PSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:COWBOY PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-347-2717
Mailing Address - Street 1:1123 BIG HORN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-2814
Mailing Address - Country:US
Mailing Address - Phone:307-347-2717
Mailing Address - Fax:307-347-2713
Practice Address - Street 1:1123 BIG HORN AVE STE A
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-2814
Practice Address - Country:US
Practice Address - Phone:307-347-2717
Practice Address - Fax:307-347-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY497261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)