Individual
TODD BADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA,LPC
Contact information
Practice address
724 FRONT ST, SUITE 511, EVANSTON, WY 82931
(307) 799-8640
(307) 789-2866
Mailing address
PO BOX 492, EVANSTON, WY 82931-0492
(307) 799-8640
(307) 789-2866
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-519
WY
101YA0400X
Addiction (Substance Use Disorder) Counselor
512
WY
101YP2500X
Professional Counselor
512
WY
Other
Enumeration date
11/06/2009
Last updated
10/23/2012
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