NPIMap

Organization Active NPI

Big Horn Psychological Services LC

  • Clinical Psychologist
  • Sheridan, WY
National Provider Identifier
1336473859
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
BIG HORN PSYCHOLOGICAL SERVICES LC
Practice address
339 W Loucks St
Sheridan, WY 82801-4121
Phone
(307) 675-1805
NPI assigned
Sep 30, 2009
Last updated
Jul 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Alicia A Clark, PSYDNPI 1134216690
Title
Licensed Psychologist
Phone
(307) 675-1805

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

339 W Loucks St
Sheridan, WY 82801-4121

Mailing address

PO Box 1035
Sheridan, WY 82801-1035
Phone (307) 675-1805

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130404000150 WY Part B Supplier - Clinic/Group Practice 3375788839 Receives reassigned benefits from 8 practitioners
Practice locations: Sheridan, WY

National Provider Directory

National Provider Directory

Locations

45 E Loucks St
Ste 109
Sheridan, WY 82801
Phone (307) 673-4389

45 E Loucks St
Ste 112
Sheridan, WY 82801
Phone (307) 673-0126

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1336473859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1035",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828011035",
            "telephone_number": "307-675-1805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 W LOUCKS ST",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828014121",
            "telephone_number": "307-675-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG HORN PSYCHOLOGICAL SERVICES LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-30",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "307-675-1805",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheridan, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.