Provider Demographics
NPI:1861624678
Name:PRIMARY MENTAL HEALTH LLC
Entity type:Organization
Organization Name:PRIMARY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DECASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:307-259-3467
Mailing Address - Street 1:301 THELMA DR
Mailing Address - Street 2:PMB #464
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2325
Mailing Address - Country:US
Mailing Address - Phone:307-259-3467
Mailing Address - Fax:307-266-5155
Practice Address - Street 1:1430 WILKINGS CIRCLE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1336
Practice Address - Country:US
Practice Address - Phone:307-235-9583
Practice Address - Fax:307-265-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY18154.0972261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health