Healthcare Provider Details

I. General information

NPI: 1316168776
Provider Name (Legal Business Name): JOHN HENRY DEHLER LCSW BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W BIRCH ST GLENROCK HEALTH CENTER
GLENROCK WY
82637-0786
US

IV. Provider business mailing address

PO BOX 2217 JOHN H DEHLER
GLENROCK WY
82637-2217
US

V. Phone/Fax

Practice location:
  • Phone: 307-436-9206
  • Fax: 307-436-9730
Mailing address:
  • Phone: 307-436-2388
  • Fax: 307-436-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW482
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: