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General NPI Number Information
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NPI Number | 1952706822
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Entity Type | Organization
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Legal Business Name | SWEETWATER COUNSELING
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 3211 ENERGY LN STE 402
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City | CASPER
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State | WY
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Zip | 82604-2963
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Country | US
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Telephone | 307-337-3797
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Fax | 307-337-3797
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Provider Business Mailing Address
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Address Line | 3211 ENERGY LN STE 402
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City | CASPER
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State | WY
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Zip | 82604-2963
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Country | US
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Telephone | 307-337-3797
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Fax | 307-337-3797
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Authorized Official
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Title or Position | THERAPIST
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Name | DEBORAH MICHAEL
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Credential | LPC
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Telephone | 307-337-3797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1368
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 560
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 151
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License Number State | WY
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1248
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License Number State | WY
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