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940 E 3rd St Ste 102 Casper WY 82601-3200 | |
| (307) 462-4876 | |
| (307) 337-3492 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 940 E 3rd St Ste 102, Casper, Wyoming |
| Authorized Official Name and Position | Brandon Wardell (PRESIDENT) |
| Authorized Official Contact | 4054125468 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
301 Thelma Dr Ste 226 Casper WY 82609 Ph: (405) 412-5468 | 940 E 3rd St Ste 102 Casper WY 82601-3200 Ph: (307) 462-4876 |
| NPI Number | 1386915528 |
|---|---|
| Provider Enumeration Date | 01/19/2012 |
| Last Update Date | 11/13/2024 |
| Certification Date | 11/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386915528 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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