| Unaccompanied Student Initiative | |
|
910 W Fox Farm Rd Cheyenne WY 82007-2674 | |
| (307) 220-2391 | |
| Not Available |
| Full Name | Unaccompanied Student Initiative |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 910 W Fox Farm Rd, Cheyenne, Wyoming |
| Authorized Official Name and Position | Tamara Moore (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3072202391 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Unaccompanied Student Initiative Po Box 22103 Cheyenne WY 82003-2030 Ph: () - | Unaccompanied Student Initiative 910 W Fox Farm Rd Cheyenne WY 82007-2674 Ph: (307) 220-2391 |
| NPI Number | 1639700750 |
|---|---|
| Provider Enumeration Date | 01/28/2020 |
| Last Update Date | 01/28/2020 |
| Certification Date | 01/28/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639700750 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
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