Individual
ERIC RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PPC
Contact information
Practice address
265 N 4TH ST, LARAMIE, WY 82072-3131
(307) 460-8277
Mailing address
1726 MILL ST, LARAMIE, WY 82072-1924
(307) 460-8277
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PPC-1350
WY
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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