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General NPI Number Information
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NPI Number | 1770944902
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Entity Type | Individual
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Provider Name | WILLIAM NOLAN SAGE L.A.T.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 10269 HWY. 789
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City | RIVERTON
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State | WY
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Zip | 82501
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Country | US
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Telephone | 307-857-9456
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Fax | 307-460-5791
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Provider Business Mailing Address
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Address Line | PO BOX 1989
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City | RIVERTON
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State | WY
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Zip | 82501-0240
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Country | US
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Telephone | 307-857-9456
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Fax | 307-460-5791
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LAT-225
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License Number State | WY
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