Organization
CAROLJEAN BONGO PSYD LLC
Active
Organization
CAROLJEAN BONGO PSYD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROLJEAN BONGO PSYD (CLINICAL PSYCHOLOGIST)
(307) 760-1871
Entity
Organization
Contact information
Practice address
2909 BENT AVE, CHEYENNE, WY 82001-2742
(307) 760-1871
(866) 621-1893
Mailing address
PO BOX 21270, CHEYENNE, WY 82003-7025
(307) 760-1871
(866) 621-1893
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
432
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124350100
—
WY
Enumeration date
07/16/2007
Last updated
07/21/2022
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