Organization
LGBTQ TELEPSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN SHAW (OWNER)
(888) 985-4287
Entity
Organization
Contact information
Practice address
1309 COFFEEN AVE STE 1200, SHERIDAN, WY 82801-5777
(888) 985-4287
Mailing address
1309 COFFEEN AVE STE 1200, SHERIDAN, WY 82801-5777
(888) 985-4287
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/03/2021
Last updated
05/03/2021
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