Individual
JUAN JOSE HERNANDEZ-CODALLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 ROGER CANYON RD, LARAMIE, WY 82072-8902
(209) 918-8761
Mailing address
PO BOX 1733, LARAMIE, WY 82073-1733
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
92529
CA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
08/17/2013
Last updated
07/31/2023
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