Individual
JILL C FAVATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. ED, LPC
Contact information
Practice address
2909 BENT AVE, THE HEALING CENTER, CHEYENNE, WY 82001-2742
(307) 286-5279
Mailing address
1213 TAFT AVE, APT. B, CHEYENNE, WY 82001-6860
(307) 286-5279
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
910
WY
101YM0800X
Mental Health Counselor
910
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
312408
BS
WY
Enumeration date
11/30/2005
Last updated
06/30/2009
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