Mary Jo Jeffres PHD, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

421 Issued in WY

Legal business name

MARY JO JEFFRES PHD, LLC

Practice address

103 N 5TH St E
Riverton, WY 82501-4402

Phone

(307) 463-0890

Fax

(307) 463-0891

NPI assigned

Dec 12, 2006

Organization subpart

No

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

Authorized official

Name

Mary Jo Jeffres, PHD

Title

Owner

Phone

(307) 463-0890

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1962563361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 N 5TH ST E",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825014402",
            "telephone_number": "307-463-0890",
            "fax_number": "307-463-0891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 N 5TH ST E",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825014402",
            "telephone_number": "307-463-0890",
            "fax_number": "307-463-0891"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 E. Fremont Avenue",
            "address_purpose": "LOCATION",
            "city": "Riverton",
            "state": "WY",
            "postal_code": "825014409",
            "country_code": "US",
            "telephone_number": "307-851-7170",
            "fax_number": "866-956-5856",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARY JO JEFFRES PHD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JEFFRES",
        "authorized_official_first_name": "MARY JO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-463-0890",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WY",
            "license": "421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121869700",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timalee Madson
• Magellan Healthcare of Wyoming
• Mike Mahoney
• Paula Lynne Markowski, BSN, RN
• Tonya Dawn Martin
• Phillip Mathews
• Cyndi McAuslan
• James F. McFarlane, D.D.S.
• Marc Douglas McLaughlin, PH.D.
• Jeffrey L McMenamy, OTR

• All providers in Riverton, WY
• Clinical Psychologist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.