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General NPI Number Information
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NPI Number | 1073822508
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Entity Type | Individual
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Provider Name | JILL COLLEEN SHIRE M.A.
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Gender | Female
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 130 N ASH ST SUITE 201
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City | CASPER
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State | WY
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Zip | 82601-1821
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Country | US
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Telephone | 307-277-7802
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Fax | 877-623-7006
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Provider Business Mailing Address
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Address Line | 130 N ASH ST SUITE 201
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City | CASPER
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State | WY
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Zip | 82601-1821
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Country | US
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Telephone | 307-277-7802
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Fax | 877-623-7006
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC 276
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License Number State | WY
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