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General NPI Number Information
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NPI Number | 1558579037
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Entity Type | Individual
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Provider Name | EVAN RAY DAILY LMFT
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | PMB #333 970 WEST BROADWAY SUITE E
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City | JACKSON
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State | WY
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Zip | 83001
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Country | US
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Telephone | 307-732-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 970 W BROADWAY PMB #333 SUITE E
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City | JACKSON
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State | WY
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Zip | 83001-9475
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Country | US
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Telephone | 307-732-3200
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 093
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License Number State | WY
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