NPIMap

Organization Active NPI

Lgbtq Telepsychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Sheridan, WY
National Provider Identifier
1336722859
Registry record updated Jul 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
LGBTQ TELEPSYCHIATRY
Practice address
1309 Coffeen Ave Ste 1200
Sheridan, WY 82801-5777
Phone
(888) 985-4287
NPI assigned
May 3, 2021
Last updated
Jul 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2026

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

Authorized official

Name
Jonathan ShawNPI 1023641743
Title
Owner
Phone
(888) 985-4287

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
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

1309 Coffeen Ave Ste 1200
Sheridan, WY 82801-5777

Mailing address

1309 Coffeen Ave Ste 1200
Sheridan, WY 82801-5777
Phone (888) 985-4287

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250620000273 OR Part B Supplier - Clinic/Group Practice 5890207492 Receives reassigned benefits from 35 practitioners
Practice locations: Eugene, OR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785283200000",
    "number": "1336722859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 COFFEEN AVE STE 1200",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828015777",
            "telephone_number": "888-985-4287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 COFFEEN AVE STE 1200",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828015777",
            "telephone_number": "888-985-4287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LGBTQ TELEPSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-985-4287"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "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 29, 2026; 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.