Provider Demographics
NPI:1912871831
Name:WYOMING CARE COLLABORATIVE LLC
Entity type:Organization
Organization Name:WYOMING CARE COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ULIANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:VAN HOUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-285-8656
Mailing Address - Street 1:556 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3124
Mailing Address - Country:US
Mailing Address - Phone:307-285-8656
Mailing Address - Fax:
Practice Address - Street 1:556 E 6TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3124
Practice Address - Country:US
Practice Address - Phone:307-285-8656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health