Healthcare Provider Details

I. General information

NPI: 1982144614
Provider Name (Legal Business Name): KRISTI LYNN VIGIL LPC-1905
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 23RD ST
WORLAND WY
82401-3725
US

IV. Provider business mailing address

401 S 23RD ST
WORLAND WY
82401-3725
US

V. Phone/Fax

Practice location:
  • Phone: 307-347-6165
  • Fax: 307-347-6166
Mailing address:
  • Phone: 307-347-6165
  • Fax: 307-347-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPPC1043
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-1905
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-1905
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: