Healthcare Provider Details

I. General information

NPI: 1548181456
Provider Name (Legal Business Name): GUY REGINALD HARRIS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 FARNUM ST STE 102
CASPER WY
82609-4108
US

IV. Provider business mailing address

2241 FARNUM ST STE 102
CASPER WY
82609-4108
US

V. Phone/Fax

Practice location:
  • Phone: 307-333-3513
  • Fax:
Mailing address:
  • Phone: 307-333-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1949
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: