Healthcare Provider Details

I. General information

NPI: 1366099871
Provider Name (Legal Business Name): CECELIA BAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6951 BOOT STRAP CT
CHEYENNE WY
82001-8569
US

IV. Provider business mailing address

6951 BOOT STRAP CT
CHEYENNE WY
82001-8569
US

V. Phone/Fax

Practice location:
  • Phone: 928-606-7433
  • Fax:
Mailing address:
  • Phone: 928-606-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1906
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: