| Teton Wellness Affiliates | |
|
125 E Pearl Ave Ste B005 Jackson WY 83001-8599 | |
| (307) 699-5025 | |
| Not Available |
| Full Name | Teton Wellness Affiliates |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 125 E Pearl Ave Ste B005, Jackson, Wyoming |
| Authorized Official Name and Position | Lorraine Thompson (OWNER) |
| Authorized Official Contact | 3076995025 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Teton Wellness Affiliates Po Box 2019 Jackson WY 83001-2019 Ph: (307) 699-5025 | Teton Wellness Affiliates 125 E Pearl Ave Ste B005 Jackson WY 83001-8599 Ph: (307) 699-5025 |
| NPI Number | 1407480890 |
|---|---|
| Provider Enumeration Date | 02/25/2020 |
| Last Update Date | 06/23/2020 |
| Certification Date | 06/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407480890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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