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General NPI Number Information
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NPI Number | 1578035846
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Entity Type | Organization
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Legal Business Name | BROOKRIDGE COUNSELING SERVICES INC
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 145 S DURBIN ST STE 104
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City | CASPER
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State | WY
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Zip | 82601-2538
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Country | US
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Telephone | 307-267-6779
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Fax | 307-333-0376
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Provider Business Mailing Address
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Address Line | 145 S DURBIN ST STE 104
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City | CASPER
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State | WY
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Zip | 82601-2538
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Country | US
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Telephone | 307-267-6779
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Fax | 307-333-0376
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. CYNTHIA ANN REPASKY
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Credential | MSW, LCSW
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Telephone | 307-267-6779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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