Kintsugi Psychiatry, Llc

LBN: Kintsugi Psychiatry, Llc
Kintsugi Psychiatry, Llc is an health care organization with primary practice located at 145 S Durbin St Ste 108 , Casper WY 82601-2566. The organization recently has 3 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Adult Mental Health, Ambulatory Health Care Facilities / Adolescent and Children Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is the primary health care specialty. Kintsugi Psychiatry, Llc can be contacted via phone (307) 333-5757, or through Madetzke, Katie via phone (307) 333-5757.

Contact Information

Primary practice address
145 S Durbin St Ste 108 Casper WY 82601-2566
Phone: (307) 333-5757
Fax: (307) 439-2141
Website:
Map and Directions
Authorized official contact:
Name: Madetzke, Katie Certified in Nursing Administration (CNA)
Phone: (307) 333-5757

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Adult Mental Health 261QM0850X
Ambulatory Health Care Facilities / Adolescent and Children Mental Health 261QM0855X
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X

Profile Details

NPI number 1306406509
LBN Legal business name Kintsugi Psychiatry, Llc
DBA Doing business as
Authorized official Madetzke, Katie Certified in Nursing Administration (CNA)
Entity Organization
Organization subpart 1 No
Enumeration date Jun 19th, 2019
Last updated Jun 17th, 2022 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306406509 NPPES
Wyoming MEDICAID 1306406509
Wyoming MEDICAID 1093117210

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