| Caroljean Bongo Psyd Llc | |
|
2909 Bent Ave Cheyenne WY 82001-2742 | |
| (307) 760-1871 | |
| (866) 621-1893 |
| Full Name | Caroljean Bongo Psyd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2909 Bent Ave, Cheyenne, Wyoming |
| Authorized Official Name and Position | Caroljean Bongo (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 3077601871 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Caroljean Bongo Psyd Llc Po Box 21270 Cheyenne WY 82003-7025 Ph: (307) 760-1871 | Caroljean Bongo Psyd Llc 2909 Bent Ave Cheyenne WY 82001-2742 Ph: (307) 760-1871 |
| NPI Number | 1821297102 |
|---|---|
| Provider Enumeration Date | 07/16/2007 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 7416049382 |
|---|---|
| Medicare Enrollment ID | O20070823000100 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821297102 | NPI | - | NPPES |
| 124350100 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 432 (Wyoming) | Primary |
| Provider Name | Caroljean Bongo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134220189 PECOS PAC ID: 6002913035 Enrollment ID: I20070525000157 |
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