Individual
TINA DALL STATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
450 MOUNTAIN VIEW, BUILDING C, POWELL, WY 82435-1958
(307) 254-0661
Mailing address
652 CEDARWOOD DR, POWELL, WY 82435-1743
(307) 254-0661
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC 926
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
314239
BCBS/WY
WY
Enumeration date
07/27/2006
Last updated
07/21/2021
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