Healthcare Provider Details

I. General information

NPI: 1336123777
Provider Name (Legal Business Name): SHERRI J RUBECK MA, LPC #539
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 CENTRAL AVE STE 302
CHEYENNE WY
82001-4557
US

IV. Provider business mailing address

1620 CENTRAL AVE STE 302
CHEYENNE WY
82001-4557
US

V. Phone/Fax

Practice location:
  • Phone: 307-221-9791
  • Fax: 307-635-3965
Mailing address:
  • Phone: 307-221-9791
  • Fax: 307-635-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number539
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: