Individual
DAVID DEMOREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC(WYOMING 1288)
Contact information
Practice address
7520 PORCUPINE CREEK RD, JACKSON, WY 83001
(307) 259-1865
(307) 200-0290
Mailing address
P.O BOX 11390, 610 W BROADWAY,, JACKSON, WY 83002
(307) 734-0017
(307) 200-0290
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC 1288
WY
Other
Enumeration date
09/19/2012
Last updated
12/19/2012
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