Provider Demographics
NPI:1154589018
Name:WYOMING HEALTHY OPTIONA & ALTERNATIVES INC
Entity type:Organization
Organization Name:WYOMING HEALTHY OPTIONA & ALTERNATIVES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDEA
Authorized Official - Middle Name:LAUREL ISAACSON
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:307-324-0092
Mailing Address - Street 1:PO BOX 782
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-0782
Mailing Address - Country:US
Mailing Address - Phone:307-324-0092
Mailing Address - Fax:307-324-0092
Practice Address - Street 1:1015 ASH
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-0000
Practice Address - Country:US
Practice Address - Phone:307-324-0092
Practice Address - Fax:307-324-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY446261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center