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General NPI Number Information
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NPI Number | 1760502009
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Entity Type | Organization
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Legal Business Name | CHOICE COUNSELING
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 1208 E PERSHING BLVD
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City | CHEYENNE
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State | WY
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Zip | 82001-3230
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Country | US
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Telephone | 307-220-3902
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 WINDMILL RD
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City | CHEYENNE
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State | WY
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Zip | 82009-5265
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Country | US
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Telephone | 307-220-2901
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Fax | 866-397-4865
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MICHAEL A DIETERS
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Credential | MS, LPC
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Telephone | 307-220-3901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC 893
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License Number State | WY
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