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Organization
LISA OTTO, LCSW LLC
Active
Organization
LISA OTTO, LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA OTTO LCSW (CEO)
(307) 760-2517
Entity
Organization
Contact information
Practice address
121 E GRAND AVE STE 209, LARAMIE, WY 82070-3652
(307) 760-2517
Mailing address
PO BOX 982, LARAMIE, WY 82073-0982
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851707574
NPI
—
Enumeration date
04/26/2021
Last updated
04/26/2021
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