Individual
DR. BRYAN K MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
120 S 17TH ST, WORLAND, WY 82401-3637
(307) 272-5368
(307) 347-4038
Mailing address
PO BOX 605, WORLAND, WY 82401-0605
(307) 272-5368
(307) 347-4038
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
#535
WY
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
103TS0200X
School Psychologist
—
—
Other
Enumeration date
01/25/2010
Last updated
05/07/2015
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