Individual
WILLIAM SHUTTS II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1841 MADORA AVE, DOUGLAS, WY 82633-3057
(307) 358-2846
(307) 358-1144
Mailing address
1841 MADORA AVE, DOUGLAS, WY 82633-3057
(307) 358-2846
(307) 358-1144
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PPC# 638
WY
101YA0400X
Addiction (Substance Use Disorder) Counselor
LAT #351
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225003023
—
WY
05
—
1932229523
—
WY
Enumeration date
06/08/2015
Last updated
06/08/2015
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