Healthcare Provider Details

I. General information

NPI: 1700700929
Provider Name (Legal Business Name): BRANDON SEGO M.A., PPC, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LOGAN AVE
CHEYENNE WY
82001-5138
US

IV. Provider business mailing address

5304 HONEYCOMB AVE
TIMNATH CO
80547-2387
US

V. Phone/Fax

Practice location:
  • Phone: 307-514-9445
  • Fax:
Mailing address:
  • Phone: 303-883-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-2603
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: