Provider Demographics
NPI:1033306097
Name:WYOMING CREATIVE COUNSELING OPTIONS, INC.
Entity Type:Organization
Organization Name:WYOMING CREATIVE COUNSELING OPTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PSYCHOLOGY
Authorized Official - Phone:307-321-1426
Mailing Address - Street 1:204 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5633
Mailing Address - Country:US
Mailing Address - Phone:307-321-1426
Mailing Address - Fax:
Practice Address - Street 1:204 5TH ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5633
Practice Address - Country:US
Practice Address - Phone:307-321-1426
Practice Address - Fax:307-324-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY446103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty