Provider Demographics
NPI:1386780427
Name:WYOMING CHILD & FAMILY DEV. INC
Entity type:Organization
Organization Name:WYOMING CHILD & FAMILY DEV. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-836-2751
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:126 NORTH WYOMING
Mailing Address - City:GUERNSEY
Mailing Address - State:WY
Mailing Address - Zip Code:82214-0100
Mailing Address - Country:US
Mailing Address - Phone:307-836-2751
Mailing Address - Fax:
Practice Address - Street 1:126 NORTH WYOMING
Practice Address - Street 2:
Practice Address - City:GUERNSEY
Practice Address - State:WY
Practice Address - Zip Code:82214-0100
Practice Address - Country:US
Practice Address - Phone:307-836-2751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities