Active NPI
Bryan K Mickelson, PH.D.
- Clinical Psychologist
- Worland, WY
National Provider Identifier
1033440466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- #535
- Practice address
- 120 S 17TH St
Worland, WY 82401-3637 - Phone
- (307) 272-5368
- Fax
- (307) 347-4038
- NPI assigned
- Jan 25, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | |||
| Counseling Psychologist | 103TC1900X | |||
| Clinical Child & Adolescent Psychologist | 103TC2200X | |||
| Group Psychotherapy Psychologist | 103TP2701X | |||
| Clinical Psychologist | 103TC0700X | #535 | WY | Primary |
| School Psychologist | 103TS0200X |
Addresses
Primary practice location
120 S 17TH St
Worland, WY 82401-3637
Mailing address
PO Box 605
Worland, WY 82401-0605
Phone (307) 272-5368
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| #535 | WY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430956800000",
"number": "1033440466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 605",
"city": "WORLAND",
"state": "WY",
"postal_code": "824010605",
"telephone_number": "307-272-5368",
"fax_number": "307-347-4038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 S 17TH ST",
"city": "WORLAND",
"state": "WY",
"postal_code": "824013637",
"telephone_number": "307-272-5368",
"fax_number": "307-347-4038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKELSON",
"first_name": "BRYAN",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-25",
"last_updated": "2015-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WY",
"license": "#535",
"primary": true
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worland, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.