Individual
DUSTY PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1898 FORT RD, SHERIDAN, WY 82801-8320
(307) 675-3891
Mailing address
1417 SPAULDING ST, SHERIDAN, WY 82801-2640
(307) 751-4235
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-1702
WY
Other
Enumeration date
12/18/2017
Last updated
12/18/2017
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