Healthcare Provider Details

I. General information

NPI: 1669599619
Provider Name (Legal Business Name): RAYMOND G. LEUGERS PSY. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W LOUCKS ST
SHERIDAN WY
82801-4128
US

IV. Provider business mailing address

425 W LOUCKS ST
SHERIDAN WY
82801-4128
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-2468
  • Fax: 307-672-2469
Mailing address:
  • Phone: 307-672-2468
  • Fax: 307-672-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number109
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: