SCOTT CLEM (NPI# 1063890341) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063890341 |
| Entity Type | Individual |
| Full Name | SCOTT CLEM |
| Practice Address |
905 N Gurley Ave Gillette WY 82716-2109 |
| Practice Telephone | 3076860669 |
| Mailing Telephone | 3076860669 |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2015-05-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 020407A2 | WY | Residential Treatment Facilities |
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | 3076860669 | 05 |
| Street Address |
905 N GURLEY AVE |
| City | GILLETTE |
| State | WY |
| Zip Code | 82716-2109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154948040 | Kiley Myers | Social Worker | 905 N Gurley Ave, Gillette, WY 82716-2109 | 2020-06-26 |
| 1750941464 | Jessica Sue Jaycox | Social Worker | 905 N Gurley Ave, Gillette, WY 82716-2109 | 2019-06-14 |
| 1679047922 | Amy Darlene Weber | Counselor | 905 N Gurley Ave, Gillette, WY 82716-2109 | 2019-01-18 |
| 1336640606 | Erin Urbanoski | Social Worker | 905 N Gurley Ave, Gillette, WY 82716-2109 | 2018-02-22 |
| 1780183970 | Jennifer Gauthier Felion | Counselor | 905 N Gurley Ave, Gillette, WY 82716 | 2018-02-02 |
| 1154829414 | Karla Jo Rosario | Case Manager/Care Coordinator | 905 N Gurley Ave, Gillette, WY 82716-2109 | 2018-01-31 |
| 1902316573 | Amber Friedlan | Counselor | 905 N Gurley Ave, Gillette, WY 82716-2109 | 2017-10-09 |
| 1114443108 | Trey Jodozi | Case Manager/Care Coordinator | 905 N Gurley Ave, Gillette, WY 82716-2109 | 2017-08-21 |
| 1811424500 | Johnny Neal II | Case Manager/Care Coordinator | 905 N Gurley Ave, Gillette, WY 82716-2109 | 2017-05-12 |
| 1467990879 | Taylor Fleming | Community/Behavioral Health | 905 N Gurley Ave, Gillette, WY 82716-2109 | 2017-02-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053822387 | Diana Lynn Ohman | Dietitian, Registered | 709 West Eighth Street, Suite 4, Gillette, WY 82716 | 2017-10-13 |
| 1821457821 | Courage To Change Counseling LLC | Community/Behavioral Health | 113 S. Gillette Ave, Gillette, WY 82716 | 2016-02-18 |
| 1003290594 | Kris Huber | Community/Behavioral Health | 905 Gurley Ave, Gillette, WY 82716 | 2015-07-14 |
| 1649516857 | Shirley L Haley | Nurse Practitioner | 1304 West 4th Street, Gillette, WY 82716 | 2012-12-14 |
| 1174867188 | Rebecca J Mader | Registered Nurse | 501 South Burma Ave., Gillette, WY 82716 | 2012-11-15 |
| 1568728228 | Kerry Elizabeth Warner | Registered Nurse | 201 S Burma Ave, Gillette, WY 82716 | 2012-04-07 |
| 1720363351 | Julie Ann Faldalen | Licensed Practical Nurse | 501 South Burma, Gillette, WY 82716 | 2011-10-14 |
| 1083937486 | Clear Creek Counseling LLC | Counselor | 801 E. 4th St., Suite 24, Gillette, WY 82716 | 2010-03-12 |
| 1821241423 | Dianna L Knox | Counselor | 500 S Burma Ave, Gillette, WY 82716 | 2008-10-28 |
| 1588826887 | Scott R Hunter | Chiropractor | 439 Prairie View Place Ste D, Dr S R Hunter, Gillette, WY 82716 | 2008-06-27 |
| Find all providers in zip 82716 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437328663 | Northeast Wyoming Boces | Residential Treatment Facility, Emotionally Disturbed Children | 410 N Miller Ave, Gillette, WY 82716-2929 | 2008-02-21 |
| 1649493453 | Youth Emergency Services | Residential Treatment Facility, Emotionally Disturbed Children | 706 Longmont St, Gillette, WY 82716-2927 | 2007-04-10 |
| 1336393834 | Youth Emergency Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 700 Longmont St, Gillette, WY 82716-2927 | 2008-11-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801159447 | Region V Boces | Residential Treatment Facility, Emotionally Disturbed Children | 3850 North Wilderness Drive, Wilson, WY 83014-0240 | 2012-06-19 |
| 1649431826 | Cornerstone Programs Corporation | Residential Treatment Facility, Emotionally Disturbed Children | 3304 E I-80 Service Rd, Cheyenne, WY 82009-8781 | 2008-06-20 |
| 1144414780 | Teton Youth and Family Services | Residential Treatment Facility, Emotionally Disturbed Children | 7905 S. Fall Creek Rd., Wilson, WY 83014-0290 | 2007-08-28 |
| 1578685863 | C-v Ranch Region V Boces | Residential Treatment Facility, Emotionally Disturbed Children | 3850 N. Wilderness Dr., Wilson, WY 83014 | 2007-04-06 |
| 1639217144 | Northwest Wyoming Boces | Residential Treatment Facility, Emotionally Disturbed Children | 250 East Arapahoe Street, Thermopolis, WY 82443 | 2007-02-05 |
| 1174679195 | Normative Services, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 5 Lane Lane, Sheridan, WY 82801-8630 | 2007-01-25 |
| 1831442201 | Region V Board of Cooperative Educational Services | Residential Treatment Facility, Emotionally Disturbed Children | 3850 North Wilderness Drive, Wilson, WY 83025 | 2012-10-22 |
| 1821370453 | Cornerstone Programs Corporation | Residential Treatment Facility, Emotionally Disturbed Children | 3304 E I-80 Service Rd, Cheyenne, WY 82009-8781 | 2011-09-09 |
| 1376688580 | St. Joseph's Children's Home | Residential Treatment Facility, Emotionally Disturbed Children | 1419 Main St, Torrington, WY 82240-3340 | 2007-02-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.