Individual
RICKIE L LABOUNTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAP
Contact information
Practice address
1841 MADORA AVE, DOUGLAS, WY 82633-3057
(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
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAP-174
WY
171M00000X
Case Manager/Care Coordinator
—
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106402907
—
WY
05
—
106402908
—
WY
Enumeration date
06/28/2018
Last updated
01/31/2019
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