| Big Horn Basin Mental Health Group | |
|
1054 Vali Rd Powell WY 82435-9259 | |
| (307) 754-3860 | |
| Not Available |
| Full Name | Big Horn Basin Mental Health Group |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1054 Vali Rd, Powell, Wyoming |
| Authorized Official Name and Position | Gibson B. Condie (PSYCHOLOGIST) |
| Authorized Official Contact | 3077543860 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Big Horn Basin Mental Health Group 1054 Vali Rd Powell WY 82435-9259 Ph: (307) 754-3860 | Big Horn Basin Mental Health Group 1054 Vali Rd Powell WY 82435-9259 Ph: (307) 754-3860 |
| NPI Number | 1366658601 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 10/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366658601 | NPI | - | NPPES |
| 124068400 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | SP03 (Wyoming) | Primary |
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