Provider Demographics
NPI:1669204632
Name:STEAMBOAT PSYCHIATRY LLC
Entity type:Organization
Organization Name:STEAMBOAT PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAI
Authorized Official - Middle Name:
Authorized Official - Last Name:WENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:307-251-7220
Mailing Address - Street 1:1301 S WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2936
Mailing Address - Country:US
Mailing Address - Phone:307-251-7220
Mailing Address - Fax:307-333-0342
Practice Address - Street 1:1301 S WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2936
Practice Address - Country:US
Practice Address - Phone:307-251-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-17
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty