Individual
OCTAVIA ALICIA GALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2232 DELL RANGE BLVD STE 270, CHEYENNE, WY 82009-4980
(307) 222-9015
Mailing address
2232 DELL RANGE BLVD STE 270, CHEYENNE, WY 82009-4980
(307) 222-9015
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
PPC-1048
WY
101YP2500X
Professional Counselor
Primary
LPC-1899
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148935600
—
WY
Enumeration date
01/18/2018
Last updated
11/05/2020
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