Healthcare Provider Details

I. General information

NPI: 1699303826
Provider Name (Legal Business Name): NANCY A WALDROP LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E BROADWAY AVE STE 201
JACKSON WY
83001-8640
US

IV. Provider business mailing address

PO BOX 428
JACKSON WY
83001-0428
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-7222
  • Fax: 307-733-9720
Mailing address:
  • Phone: 307-733-3636
  • Fax: 877-205-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number42785
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-1890
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: