Individual
ELIZABETH KOUTRELAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
320 E BROADWAY AVE, JACKSON, WY 83001
(307) 200-9882
Mailing address
755 E NEZ PERCE RD, JACKSON, WY 83001-9382
(307) 200-9882
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-1192
WY
Other
Enumeration date
05/07/2019
Last updated
09/11/2019
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