Individual
MR. WYATT DANE CARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PLADC
Contact information
Practice address
322 NORRIS AVE, #5, MC COOK, NE 69001-3700
(308) 345-5592
Mailing address
322 NORRIS AVE, #5, MC COOK, NE 69001-3700
(308) 345-5592
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
P-628
NE
Other
Enumeration date
08/27/2008
Last updated
08/27/2008
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