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General NPI Number Information
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NPI Number | 1457634040
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Entity Type | Organization
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Legal Business Name | THE CLINIC FOR MENTAL HEALTH AND WELLNESS
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 504 SOUTH 4TH STREET
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City | LARAMIE
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State | WY
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Zip | 82070
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Country | US
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Telephone | 307-755-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 504 S 4TH ST
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City | LARAMIE
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State | WY
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Zip | 82070-3704
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. MARTHA NESSLINGER
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Credential |
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Telephone | 307-755-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-992
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License Number State | WY
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