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General NPI Number Information
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NPI Number | 1073970349
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Entity Type | Organization
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Legal Business Name | COUNSELING AND PLAY THERAPY CENTER OF WYOMING, LLC
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Dates
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Enumeration Date | 01/18/2016
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Last Update Date | 01/18/2016
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Provider Practice Location Address
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Address Line | 140 S MAIN ST
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City | BUFFALO
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State | WY
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Zip | 82834-1846
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Country | US
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Telephone | 307-620-1507
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Fax |
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Provider Business Mailing Address
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Address Line | 46 RUSTLERS TRL
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City | BUFFALO
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State | WY
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Zip | 82834-2461
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Country | US
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Telephone | 307-620-1507
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE LYNN FRAZIER STRAESSLER
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Credential | LPC, RPT-S
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Telephone | 307-620-1507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC-1139
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License Number State | WY
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