Provider Demographics
NPI:1194741868
Name:EQUALITY CONNECTIONS PC
Entity type:Organization
Organization Name:EQUALITY CONNECTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:STERNITZKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-638-4625
Mailing Address - Street 1:821 W PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2537
Mailing Address - Country:US
Mailing Address - Phone:307-638-4625
Mailing Address - Fax:307-635-3965
Practice Address - Street 1:821 W PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2537
Practice Address - Country:US
Practice Address - Phone:307-638-4625
Practice Address - Fax:307-635-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY101YM0800X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY121793300Medicaid