Individual
ALEX DIMITRIJEVIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
502 S 4TH ST, LARAMIE, WY 82070-3704
(307) 755-1000
(307) 742-9717
Mailing address
502 S 4TH ST, LARAMIE, WY 82070-3704
(307) 755-1000
(307) 742-9717
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-1754
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
314626
BLUE CROSS BLUE SHEILD
WY
Enumeration date
11/20/2006
Last updated
02/21/2019
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