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Clinical >> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1518013549

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 307-746-4456  Fax: 307-746-4470

Contact information for business:
25090 HIGHWAY 85  NEWCASTLE, WY 82701 US
Tel: 307-746-3609  Fax: 307-746-4470

Registration Information:
NPI: 1518013549
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker

Legacy codes, insurance codes and state license numbers:



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