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General NPI Number Information
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NPI Number | 1881948800
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Entity Type | Organization
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Legal Business Name | DAN COSSABOON GROUP
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 1001 14TH ST
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City | CODY
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State | WY
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Zip | 82414-3745
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Country | US
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Telephone | 307-527-5432
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 14TH ST
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City | CODY
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State | WY
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Zip | 82414-3745
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Country | US
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Telephone | 307-527-5432
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DANIEL S COSSABOON
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Credential | PSYD
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Telephone | 307-250-7527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 440
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License Number State | WY
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