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General NPI Number Information
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NPI Number | 1851707574
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Entity Type | Individual
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Provider Name | LISA OTTO
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Gender | Female
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 1607 CAPITOL AVE FL THE2
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City | CHEYENNE
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State | WY
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Zip | 82001
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Country | US
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Telephone | 307-630-4729
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Fax | 307-632-3298
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Provider Business Mailing Address
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Address Line | PO BOX 982
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City | LARAMIE
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State | WY
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Zip | 82073-0982
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Country | US
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Telephone | 307-630-4729
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Fax | 307-632-3298
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | PCSW-583
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-983
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 983
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License Number State | WY
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