Healthcare Provider Details

I. General information

NPI: 1013826114
Provider Name (Legal Business Name): VITALITY ARCHITECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 E CLARK ST
LARAMIE WY
82072-3227
US

IV. Provider business mailing address

603 E CLARK ST
LARAMIE WY
82072-3227
US

V. Phone/Fax

Practice location:
  • Phone: 307-760-1172
  • Fax:
Mailing address:
  • Phone: 307-760-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSE JOHNSTON
Title or Position: THERAPIST
Credential: MS, LPC
Phone: 307-760-1172