Individual
MR. JERRY LEWIS ALVIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CAP
Contact information
Practice address
2360 E PERSHING BLVD, CHEYENNE, WY 82001-5356
(307) 778-7550
(307) 778-7393
Mailing address
2360 E PERSHING BLVD, CHEYENNE, WY 82001-5356
(307) 778-7550
(307) 778-7393
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAP046A
WY
Other
Enumeration date
04/27/2006
Last updated
07/08/2007
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