=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528765823
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN ALVORD THAYER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2023
-----------------------------------------------------
Last Update Date | 02/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 619 WEST 5TH STREET 629
-----------------------------------------------------
City | LUSK
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82225-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-334-2224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 619 WEST 5TH STREET BOX 629
-----------------------------------------------------
City | LUSK
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-334-3793
-----------------------------------------------------
Fax | 307-334-0126
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------