Individual
RICHARD DOUG BEBOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
535 PIONEER AVE, RIVERTON, WY 82501-3248
(307) 709-0290
Mailing address
535 PIONEER AVE, RIVERTON, WY 82501-3248
(307) 709-0290
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
06/29/2020
Last updated
06/29/2020
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