Healthcare Provider Details

I. General information

NPI: 1811408974
Provider Name (Legal Business Name): MELONY RAY SANFORD M. ED. LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 MARTIN AVE
SHERIDAN WY
82801-5520
US

IV. Provider business mailing address

1333 MARTIN AVE
SHERIDAN WY
82801-5520
US

V. Phone/Fax

Practice location:
  • Phone: 64-839-7445
  • Fax: 307-672-8950
Mailing address:
  • Phone: 64-839-7445
  • Fax: 307-672-8950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1054-3-1-20-492
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-1783
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: