Healthcare Provider Details

I. General information

NPI: 1225833460
Provider Name (Legal Business Name): CASSANDRA LOIS CRUMPTON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E PINE ST APT 201
PINEDALE WY
82941-5350
US

IV. Provider business mailing address

31 ANTELOPE TRL
PINEDALE WY
82941-9026
US

V. Phone/Fax

Practice location:
  • Phone: 307-734-6040
  • Fax:
Mailing address:
  • Phone: 307-705-8345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPPC-1549
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: