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General NPI Number Information
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NPI Number | 1740763903
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Entity Type | Organization
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Legal Business Name | DONNA J. ANDRUS
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 125 E PEARL AVE
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City | JACKSON
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State | WY
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Zip | 83001-8599
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Country | US
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Telephone | 307-730-4793
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 102
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City | JACKSON
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State | WY
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Zip | 83001-0102
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Country | US
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Telephone | 307-730-4793
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | DONNA ANDRUS
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Credential |
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Telephone | 307-730-4793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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