Active NPI
McKenzie Suzanne Myers
- Clinical Social Worker
- Jackson, WY
National Provider Identifier
1699556076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- PCSW-1125
- Practice address
- 420 W Pearl Ave
Jackson, WY 83001-8409 - Phone
- (307) 734-6040
- NPI assigned
- Oct 11, 2023
- Sex
- Female
- 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 Social Worker | 1041C0700X | PCSW-1125 | WY | Primary |
Addresses
Primary practice location
420 W Pearl Ave
Jackson, WY 83001-8409
Mailing address
403 E Bradley St
Laramie, WY 82072-3139
Phone (207) 317-6729
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCSW-1125 | WY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TBT, LLC | Current | Accepting new patients | |
| Teton Behavior Therapy | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Jackson, WY
- NPI 1407230766
-
- Clinical Social Worker
- Jackson, WY
- NPI 1336072206
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696982400000",
"number": "1699556076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 E BRADLEY ST",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820723139",
"telephone_number": "207-317-6729"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W PEARL AVE",
"city": "JACKSON",
"state": "WY",
"postal_code": "830018409",
"telephone_number": "307-734-6040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYERS",
"first_name": "MCKENZIE",
"middle_name": "SUZANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-11",
"last_updated": "2023-10-11",
"certification_date": "2023-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WY",
"license": "PCSW-1125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.