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General NPI Number Information
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NPI Number | 1336865088
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Entity Type | Individual
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Provider Name | LARS MICHAEL FLANAGAN
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Gender | Male
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 2001 W SUNSET DR
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City | RIVERTON
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State | WY
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Zip | 82501-2256
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Country | US
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Telephone | 307-856-9491
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Fax |
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Provider Business Mailing Address
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Address Line | 121 N 5TH ST W
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City | RIVERTON
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State | WY
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Zip | 82501-3453
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Country | US
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Telephone | 307-856-9407
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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 | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | PTSB36486
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License Number State | WY
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