Individual
MYRON LITTLEBIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
28 BLACK COAL DR, FORT WASHAKIE, WY 82514-0638
(307) 332-2203
Mailing address
PO BOX 638, 28 BLACK COAL DR, FORT WASHAKIE, WY 82514-0638
(307) 332-2203
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
716
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265751309
—
WY
Enumeration date
06/21/2012
Last updated
06/21/2012
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