Provider Demographics
NPI:1861577017
Name:WYOMING BEHAVIORAL INSTITUTE
Entity type:Organization
Organization Name:WYOMING BEHAVIORAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST- MENTAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANCLIFT
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:307-362-8701
Mailing Address - Street 1:79 WINSTON DR
Mailing Address - Street 2:SUITE 121 GATEWAY OFFICE CENTER
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5768
Mailing Address - Country:US
Mailing Address - Phone:307-362-8701
Mailing Address - Fax:307-362-3559
Practice Address - Street 1:79 WINSTON DR
Practice Address - Street 2:SUITE 121 GATEWAY OFFICE CENTER
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5768
Practice Address - Country:US
Practice Address - Phone:307-362-8701
Practice Address - Fax:307-362-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY223101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty