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General NPI Number Information
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NPI Number | 1063673069
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Entity Type | Individual
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Provider Name | BRANDON CLARK WARDELL LPC
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Gender | Male
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 940 E 3RD ST STE 105
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City | CASPER
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State | WY
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Zip | 82601-3200
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Country | US
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Telephone | 405-412-5468
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Fax |
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Provider Business Mailing Address
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Address Line | 301 THELMA DR # 226
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City | CASPER
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State | WY
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Zip | 82609-2325
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Country | US
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Telephone | 405-412-5468
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2068
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License Number State | WY
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