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General NPI Number Information
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NPI Number | 1083941389
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Entity Type | Individual
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Provider Name | TODD BADER MA,LPC
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Gender | Male
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 724 FRONT ST SUITE 511
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City | EVANSTON
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State | WY
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Zip | 82931
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Country | US
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Telephone | 307-799-8640
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Fax | 307-789-2866
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Provider Business Mailing Address
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Address Line | PO BOX 492
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City | EVANSTON
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State | WY
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Zip | 82931-0492
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Country | US
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Telephone | 307-799-8640
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Fax | 307-789-2866
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 512
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 512
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-519
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License Number State | WY
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