Individual
BENJAMIN CLANCY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4989 NORTH 3RD STREET, LARAMIE, WY 82072-9548
(307) 745-8997
(307) 742-6146
Mailing address
4989 NORTH 3RD STREET, LARAMIE, WY 82072-9548
(307) 745-8997
(307) 742-6146
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
PPC-834
WY
101YP2500X
Professional Counselor
Primary
LPC-1564
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC-1564
STATE LICENSE
WY
01
—
PPC-834
MENTAL HEALTH PROFESSIONS LICENSING BOARD
WY
Enumeration date
07/02/2014
Last updated
05/23/2016
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