| Premium Mental Health Inc | |
|
1262 N 22nd St Unit B Laramie WY 82072-5307 | |
| (307) 742-6222 | |
| (307) 742-9233 |
| Full Name | Premium Mental Health Inc |
|---|---|
| Speciality | Counselor |
| Location | 1262 N 22nd St Unit B, Laramie, Wyoming |
| Authorized Official Name and Position | Megan Ann Smith (VICE PRESIDENT) |
| Authorized Official Contact | 3077428710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premium Mental Health Inc 1262 N 22nd St Unit B Laramie WY 82072-5307 Ph: (307) 742-6222 | Premium Mental Health Inc 1262 N 22nd St Unit B Laramie WY 82072-5307 Ph: (307) 742-6222 |
| NPI Number | 1285074476 |
|---|---|
| Provider Enumeration Date | 07/02/2013 |
| Last Update Date | 03/31/2023 |
| Certification Date | 03/31/2023 |
| Medicare PECOS PAC ID | 2961637129 |
|---|---|
| Medicare Enrollment ID | O20131024001860 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285074476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Joyce C Surdam |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336478643 PECOS PAC ID: 3678697620 Enrollment ID: I20100827000976 |
| Provider Name | Denise A Gill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619287539 PECOS PAC ID: 6507150745 Enrollment ID: I20160810001445 |
| Provider Name | Wayne R Graves |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730235300 PECOS PAC ID: 9133400856 Enrollment ID: I20170111001237 |
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