Active NPI
Brian Alan Daskivich, PH.D.
- Clinical Psychologist
- Cheyenne, WY
National Provider Identifier
1114254240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 320
- Practice address
- 2360 E Pershing Blvd
Cheyenne, WY 82001-5356 - Phone
- (307) 778-7550
- NPI assigned
- Nov 10, 2009
- Last updated
- Oct 6, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 320 | MT | Primary |
Addresses
Primary practice location
2360 E Pershing Blvd
Cheyenne, WY 82001-5356
Mailing address
PO Box 22196
Cheyenne, WY 82003-2118
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 320 | MT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381017600000",
"number": "1114254240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22196",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820032118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2360 E PERSHING BLVD",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820015356",
"telephone_number": "307-778-7550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DASKIVICH",
"first_name": "BRIAN",
"middle_name": "ALAN",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-11-10",
"last_updated": "2013-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MT",
"license": "320",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.