Provider Demographics
NPI:1043384662
Name:FERNELIUS, ERIC G (MSW LCSW CLINICAL SO)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:G
Last Name:FERNELIUS
Suffix:
Gender:M
Credentials:MSW LCSW CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 MAPLE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604
Mailing Address - Country:US
Mailing Address - Phone:307-265-4879
Mailing Address - Fax:
Practice Address - Street 1:336 S JACKSON
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-265-2555
Practice Address - Fax:307-237-1259
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW5351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical