=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871745281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAMON JUSTIN LAIRD MSW, LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2008
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 N FOREST DR # 7
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82609-1915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-315-8655
-----------------------------------------------------
Fax | 307-333-0451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 536 S CENTER ST
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-315-8655
-----------------------------------------------------
Fax | 307-333-0451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1496
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 667
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------