Jeffery D Pharaoh, MDIV MSW RMHC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LPC-1371 Issued in WY

Practice address

401 S 23Rd St
Worland, WY 82401-3725

Phone

(307) 347-6165

Fax

(307) 347-6166

NPI assigned

Nov 20, 2007

Last updated

Apr 8, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cloud Peak Counseling Center

  dba Oxbow Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Worland, WY
  • NPI 1164704029
  NPD (past)
• Cloud Peak Counseling Center

  dba Oxbow Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Worland, WY
  • NPI 1861577140
  NPD (past)

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

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396915200000",
    "number": "1558542498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S 23RD ST",
            "city": "WORLAND",
            "state": "WY",
            "postal_code": "824013725",
            "telephone_number": "307-347-6165",
            "fax_number": "307-347-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S 23RD ST",
            "city": "WORLAND",
            "state": "WY",
            "postal_code": "824013725",
            "telephone_number": "307-347-6165",
            "fax_number": "307-347-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHARAOH",
        "first_name": "JEFFERY",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "credential": "MDIV MSW RMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-20",
        "last_updated": "2014-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WY",
            "license": "LPC-1371",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela-Marie Pantelis
• Marlene Carol Paquin, M.S., L.P.C.
• Daimion M Pederson
• Grace O Peterson
• Elena Pharaoh
• Karen Pharaoh
• Philip Tallman MD PC
• James Michael Poore, PHYSICAL THERAPIST
• Psychological Services
• Sarah Elizabeth Radabaugh, D.C.

• Counselor in Worland, WY
• Providers in Worland, WY by specialty
• Counselor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.