Individual
JULIE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
46 IRON HORSE DR, ALPINE, WY 83128-8101
(307) 413-2457
Mailing address
PO BOX 6956, JACKSON, WY 83002-6956
(307) 413-2457
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
622
WY
1041C0700X
Clinical Social Worker
Primary
622
WY
Other
Enumeration date
12/24/2009
Last updated
05/06/2015
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