| I-mediatewyo Llc | |
|
520 E 18th St Cheyenne WY 82001-4618 | |
| (307) 414-0456 | |
| Not Available |
| Full Name | I-mediatewyo Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 520 E 18th St, Cheyenne, Wyoming |
| Authorized Official Name and Position | Mark Gaskill (CEO) |
| Authorized Official Contact | 3074140456 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| I-mediatewyo Llc 5731 Cochise Rd Cheyenne WY 82009-9655 Ph: (307) 414-0456 | I-mediatewyo Llc 520 E 18th St Cheyenne WY 82001-4618 Ph: (307) 414-0456 |
| NPI Number | 1962909127 |
|---|---|
| Provider Enumeration Date | 04/12/2018 |
| Last Update Date | 04/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962909127 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | PMFT-284 (Wyoming) | Primary |
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