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General NPI Number Information
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NPI Number | 1902191638
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Entity Type | Individual
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Provider Name | DIANA PAULINE QUEALY-BERGE PH.D. WY LPC
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Gender | Female
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 02/21/2014
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Provider Practice Location Address
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Address Line | 3920 SWINGLE
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City | CASPER
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State | WY
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Zip | 82604
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Country | US
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Telephone | 307-315-2536
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 235
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City | CASPER
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State | WY
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Zip | 82602-0235
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Country | US
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Telephone | 307-277-6462
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Fax |
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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 | WY LPC 386
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License Number State | WY
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