Healthcare Provider Details

I. General information

NPI: 1598988636
Provider Name (Legal Business Name): DOROTHY R CONGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOROTHY R KENDALL LPC

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CITY VIEW DR #302
EVANSTON WY
82930-5327
US

IV. Provider business mailing address

350 CITY VIEW DR #302
EVANSTON WY
82930-5327
US

V. Phone/Fax

Practice location:
  • Phone: 307-789-7915
  • Fax: 307-789-6009
Mailing address:
  • Phone: 307-789-7915
  • Fax: 307-789-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-481
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC481
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: