Frontier Psychological Associates, L C
Organization Active NPI Counselor · Evanston, WV
NPI 1679622393 · NPPES record last updated Aug 29, 2022
Key facts
- NPI
- 1679622393
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Counselor 101Y00000X
- Legal business name
- FRONTIER PSYCHOLOGICAL ASSOCIATES, L C
- Practice address
- 724 Front Street
Suite 230
Evanston, WV 82930 - Phone
- (307) 789-6773
- Fax
- (307) 789-3244
- NPI assigned
- Jan 10, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Juliet L Jett, PH.D.
- Title
- Co-Owner
- Phone
- (307) 789-6773
Practitioners 4
-
Denise Debarre, PHD
-
Juliet L Jett, PHD
-
Cora Klotzbach, PSYD
-
Julia E Murray, MED
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041014000379 | WY | Part B Supplier - Clinic/Group Practice | 4981664901 |
Receives reassigned benefits from 4 practitioners Practice locations: Evanston, WY |
National Provider Directory
Locations
724 Front St
Ste 230
Evanston, WY 82930
Phone (307) 789-6773
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor |
101Y00000X | Yes | ||
| Psychologist |
103T00000X |
Addresses
Primary practice location
724 Front Street
Suite 230
Evanston, WV 82930
Mailing address
724 Front Street
Suite 230
Evanston, WV 82930
Phone (307) 789-6773
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110414403 | Medicaid | WY |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 29, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.