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General NPI Number Information
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NPI Number | 1780019240
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Entity Type | Organization
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Legal Business Name | WYOMING ART THERAPY AND MEDICAL COUNSELING
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 920 E SHERIDAN ST SUITE B
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City | LARAMIE
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State | WY
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Zip | 82070-3868
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Country | US
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Telephone | 307-760-6125
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Fax |
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Provider Business Mailing Address
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Address Line | 920 E SHERIDAN ST SUITE B
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City | LARAMIE
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State | WY
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Zip | 82070-3868
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Country | US
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Telephone | 307-760-6125
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | MS. ANDREA A. BERRY
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Credential | MHR, ATR-BC, LPC, NC
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Telephone | 307-760-6125
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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 | 1049
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License Number State | WY
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