Healthcare Provider Details

I. General information

NPI: 1881991388
Provider Name (Legal Business Name): NORTHERN STAR COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 E 17TH ST
CHEYENNE WY
82001-4617
US

IV. Provider business mailing address

508 E 17TH ST
CHEYENNE WY
82001-4612
US

V. Phone/Fax

Practice location:
  • Phone: 307-421-9314
  • Fax:
Mailing address:
  • Phone: 307-421-9314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-850
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number267
License Number StateWY

VIII. Authorized Official

Name: JENNIFER E HARP
Title or Position: OWNER
Credential: LPC-850
Phone: 307-638-4625