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General NPI Number Information
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NPI Number | 1881991388
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Entity Type | Organization
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Legal Business Name | NORTHERN STAR COUNSELING, LLC
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 508 E 17TH ST
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City | CHEYENNE
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State | WY
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Zip | 82001-4617
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Country | US
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Telephone | 307-421-9314
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Fax |
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Provider Business Mailing Address
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Address Line | 508 E 17TH ST
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City | CHEYENNE
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State | WY
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Zip | 82001-4612
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Country | US
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Telephone | 307-421-9314
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER E HARP
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Credential | LPC-850
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Telephone | 307-638-4625
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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 | LPC-850
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 267
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License Number State | WY
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