Individual
MRS. CASSIDY DIANE PROVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PPC
Contact information
Practice address
2241 FARNUM ST STE 102, CASPER, WY 82609-4108
(307) 234-9979
(307) 234-9989
Mailing address
2241 FARNUM ST STE 102, CASPER, WY 82609-4108
(307) 234-9979
(307) 234-9989
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1151
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295286185
—
WY
Enumeration date
09/20/2019
Last updated
09/20/2019
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