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Organization
KINTSUGI PSYCHIATRY, LLC
Active
Organization
KINTSUGI PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TEECEE ANN HAILEY-FULFER (OWNER)
(307) 333-5757
Entity
Organization
Contact information
Practice address
145 S DURBIN ST STE 108, CASPER, WY 82601-2566
(307) 333-5757
(307) 439-2141
Mailing address
145 S DURBIN ST STE 108, CASPER, WY 82601-2566
(307) 333-5757
(307) 439-2141
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093117210
—
WY
05
—
1306406509
—
WY
Enumeration date
06/19/2019
Last updated
07/29/2026
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