Basic Information
| Provider Information | |||||||||
| NPI: | 1366878977 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADONAI MENTAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827164108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076858255 | ||||||||
| FaxNumber: | 8888528319 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827164108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076858255 | ||||||||
| FaxNumber: | 8888528319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2013 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | WALLA | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 3076858255 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MHNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | 29650.1122 | WY | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.