| Mindfully Reconnect Llc | |
|
1001 W 31st St Cheyenne WY 82001-2442 | |
| (307) 634-6883 | |
| (307) 634-9462 |
| Full Name | Mindfully Reconnect Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1001 W 31st St, Cheyenne, Wyoming |
| Authorized Official Name and Position | Elizabeth Ann Schroll (ONWER) |
| Authorized Official Contact | 3076346883 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindfully Reconnect Llc 1001 W 31st St Cheyenne WY 82001-2442 Ph: (307) 634-6883 | Mindfully Reconnect Llc 1001 W 31st St Cheyenne WY 82001-2442 Ph: (307) 634-6883 |
| NPI Number | 1003234774 |
|---|---|
| Provider Enumeration Date | 03/31/2014 |
| Last Update Date | 03/31/2014 |
| Medicare PECOS PAC ID | 8921231275 |
|---|---|
| Medicare Enrollment ID | O20140512001826 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003234774 | NPI | - | NPPES |
| 106079100 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LCSW 731 (Wyoming) | Primary |
| Provider Name | Elizabeth A Pollnow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124353842 PECOS PAC ID: 3375728777 Enrollment ID: I20110428000716 |
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