Organization
PROUD MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN WAYNE SHAW PMHNP (OWNER/CEO)
(657) 229-5479
Entity
Organization
Contact information
Practice address
1309 COFFEEN AVE # 19118, SHERIDAN, WY 82801-5777
(657) 229-5479
Mailing address
1309 COFFEEN AVE # 19118, SHERIDAN, WY 82801-5777
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103T00000X
Psychologist
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
03/09/2026
Last updated
03/09/2026
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