Healthcare Provider Details

I. General information

NPI: 1699479790
Provider Name (Legal Business Name): KAITLIN KIRSCH-OPFAR PPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BURMA AVE
GILLETTE WY
82716-3426
US

IV. Provider business mailing address

501 S BURMA AVE
GILLETTE WY
82716-3426
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-1000
  • Fax:
Mailing address:
  • Phone: 307-688-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPPC-1531
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: