| Outside Therapy Llc | |
|
1918 Thomes Ave Cheyenne WY 82001-3527 | |
| (307) 313-2777 | |
| Not Available |
| Full Name | Outside Therapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 1918 Thomes Ave, Cheyenne, Wyoming |
| Authorized Official Name and Position | Alyse Pfankuch (THERAPIST) |
| Authorized Official Contact | 3072210317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Outside Therapy Llc 4726 Mountain Rd Apt 520 Cheyenne WY 82009-5157 Ph: (307) 221-0317 | Outside Therapy Llc 1918 Thomes Ave Cheyenne WY 82001-3527 Ph: (307) 313-2777 |
| NPI Number | 1902652274 |
|---|---|
| Provider Enumeration Date | 04/27/2024 |
| Last Update Date | 04/05/2025 |
| Certification Date | 04/05/2025 |
| Medicare PECOS PAC ID | 8628519899 |
|---|---|
| Medicare Enrollment ID | O20240916003242 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902652274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Alyse Pfankuch |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962167098 PECOS PAC ID: 8325581366 Enrollment ID: I20240619001068 |
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