Individual
KIPP DANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
389 ADAMS, AFTON, WY 83110-0376
(307) 885-9883
Mailing address
404 NORTH SPRAGUE CREEK RD., P.O BOX 24, FAIRVIEW, WY 83119-0024
(307) 723-2252
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LAT-220
WY
101YM0800X
Mental Health Counselor
LCPC3048
ID
101YP2500X
Professional Counselor
Primary
LPC-550
WY
Other
Enumeration date
11/16/2007
Last updated
12/14/2015
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