Individual
LISA OTTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1607 CAPITOL AVE FL THE2, CHEYENNE, WY 82001
(307) 630-4729
(307) 632-3298
Mailing address
PO BOX 982, LARAMIE, WY 82073-0982
(307) 630-4729
(307) 632-3298
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
PCSW-583
WY
101YM0800X
Mental Health Counselor
Primary
983
WY
1041C0700X
Clinical Social Worker
LCSW-983
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCSW-983
STATE LICENSE
WY
01
—
PCSW-583
MENTAL HEALTH PROFESSIONS LICENSING BOARD
WY
Enumeration date
07/02/2014
Last updated
05/19/2021
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