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General NPI Number Information
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NPI Number | 1376350520
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Entity Type | Organization
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Legal Business Name | WYOMING FUNDAMENTAL HEALING AND RECOVERY LLC
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 800 WERNER CT STE 300
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City | CASPER
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State | WY
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Zip | 82601-1325
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Country | US
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Telephone | 307-439-6345
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Fax |
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Provider Business Mailing Address
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Address Line | 800 WERNER CT STE 300
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City | CASPER
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State | WY
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Zip | 82601-1325
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Country | US
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Telephone | 307-439-6345
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT JAY BARNOSKY
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Credential | LPC
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Telephone | 307-472-3769
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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 |
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License Number State |
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