NPIMap

Organization Active NPI

Lupine Mental Health and Integrative Psychiatry LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jackson, WY
National Provider Identifier
1871103127
Registry record updated Aug 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
LUPINE MENTAL HEALTH AND INTEGRATIVE PSYCHIATRY LLC
Practice address
125 E Pearl Ave Ste 207
Jackson, WY 83001-8599
Phone
(307) 203-2656
NPI assigned
Aug 2, 2020
Last updated
Aug 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2020

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

Authorized official

Name
Susan G Wolff, PMHNPNPI 1558912477
Title
Psychiatric Nurse Practitioner
Phone
(307) 203-2656

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

125 E Pearl Ave Ste 207
Jackson, WY 83001-8599

Mailing address

PO Box 1132
Jackson, WY 83001-1132

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY, ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201027002432 WY Part B Supplier - Clinic/Group Practice 8426468737 Receives reassigned benefits from 1 practitioner
Practice locations: Jackson, WY
O20230508000373 ID Part B Supplier - Clinic/Group Practice 8426468737 Receives reassigned benefits from 1 practitioner
Practice locations: Driggs, ID

National Provider Directory

National Provider Directory

Locations

89 N Main St
Driggs, ID 83422
Phone (307) 200-4948

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": "1596326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596326400000",
    "number": "1871103127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1132",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830011132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E PEARL AVE STE 207",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018599",
            "telephone_number": "307-203-2656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUPINE MENTAL HEALTH AND INTEGRATIVE PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-02",
        "last_updated": "2020-08-02",
        "certification_date": "2020-08-02",
        "status": "A",
        "authorized_official_last_name": "WOLFF",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PSYCHIATRIC NURSE PRACTITIONER",
        "authorized_official_telephone_number": "307-203-2656",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "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 Aug 2, 2020; 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.