Individual
MARK CURTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1841 MADORA AVE, DOUGLAS, WY 82633
(307) 358-2846
(307) 358-1144
Mailing address
1841 MADORA AVE, DOUGLAS, WY 82633-3057
(307) 358-2846
(307) 358-1144
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC-725
WY
101YP2500X
Professional Counselor
Primary
LPC-725
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106402908
—
WY
05
—
10640297
—
WY
Enumeration date
04/25/2017
Last updated
05/21/2018
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