| High Desert Psychology And Wellness | |
|
191 Overthrust Rd Evanston WY 82930-9261 | |
| (435) 631-9918 | |
| Not Available |
| Full Name | High Desert Psychology And Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 191 Overthrust Rd, Evanston, Wyoming |
| Authorized Official Name and Position | Adam K Fuller (PRESIDENT/CEO/CLINICAL DIRECTOR) |
| Authorized Official Contact | 4356319918 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| High Desert Psychology And Wellness 235 Hayden Ave Evanston WY 82930-5606 Ph: (435) 631-9918 | High Desert Psychology And Wellness 191 Overthrust Rd Evanston WY 82930-9261 Ph: (435) 631-9918 |
| NPI Number | 1194226266 |
|---|---|
| Provider Enumeration Date | 02/23/2018 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 4587929344 |
|---|---|
| Medicare Enrollment ID | O20180525001190 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194226266 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 306 (Wyoming) | Primary |
| Provider Name | Pamela R Fuller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053469452 PECOS PAC ID: 0244323566 Enrollment ID: I20070831000642 |
| Provider Name | Adam K Fuller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255476131 PECOS PAC ID: 9537206230 Enrollment ID: I20091029000372 |
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