Provider Demographics
NPI:1003106725
Name:LONG, LAURA CAROL (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CAROL
Last Name:LONG
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CAROL
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW #828
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:LUSK
Mailing Address - State:WY
Mailing Address - Zip Code:82225-0036
Mailing Address - Country:US
Mailing Address - Phone:307-752-9155
Mailing Address - Fax:
Practice Address - Street 1:800 WERNER CT STE 300
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-247-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW #8281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106402907Medicaid
WY106402908Medicaid