Individual
BELINDA BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCSW
Contact information
Practice address
4989 N 3RD ST, LARAMIE, WY 82072-9548
(307) 745-8997
Mailing address
4989 N 3RD ST, LARAMIE, WY 82072-9548
(307) 745-8997
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
475-PCSW
WY
104100000X
Social Worker
PCSW-475
WY
1041C0700X
Clinical Social Worker
Primary
LCSW-982
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
475-PCSW
STATE LICENSE
WY
01
—
LCSW-982
STATE LICENSE
WY
Enumeration date
10/22/2012
Last updated
05/19/2016
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