Individual
MS. THERESA J POLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS NCC LPC CAJSM
Contact information
Practice address
1263 N 15TH ST, LARAMIE, WY 82072-2343
(307) 745-8915
(307) 745-8761
Mailing address
1658 FOX RIDGE RD, LARAMIE, WY 82072-5117
(307) 745-8547
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
775
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
312403
BS OF WY
WY
Enumeration date
12/05/2006
Last updated
07/08/2007
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