Organization
MARY JO JEFFRES PHD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JO JEFFRES PHD (OWNER)
(307) 463-0890
Entity
Organization
Contact information
Practice address
103 N 5TH ST E, RIVERTON, WY 82501-4402
(307) 463-0890
(307) 463-0891
Mailing address
103 N 5TH ST E, RIVERTON, WY 82501-4402
(307) 463-0890
(307) 463-0891
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
421
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121869700
—
WY
Enumeration date
12/12/2006
Last updated
07/21/2022
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