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General NPI Number Information
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NPI Number | 1689902009
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Entity Type | Organization
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Legal Business Name | UPLIFT COUNSELING & DEVELOPMENT
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 501 W BUFFALO ST DOWNSTAIRS
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City | RAWLINS
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State | WY
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Zip | 82301-5622
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Country | US
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Telephone | 307-324-5899
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Fax | 307-324-2695
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Provider Business Mailing Address
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Address Line | PO BOX 911
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City | RAWLINS
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State | WY
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Zip | 82301-0911
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Country | US
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Telephone | 307-324-5899
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Fax | 307-324-2695
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES JUNKIN
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Credential | LPC
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Telephone | 307-324-5899
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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 | 468
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-905
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License Number State | WY
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