Provider Demographics
NPI:1073970349
Name:COUNSELING AND PLAY THERAPY CENTER OF WYOMING, LLC
Entity Type:Organization
Organization Name:COUNSELING AND PLAY THERAPY CENTER OF WYOMING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LYNN FRAZIER
Authorized Official - Last Name:STRAESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RPT-S
Authorized Official - Phone:307-620-1507
Mailing Address - Street 1:46 RUSTLERS TRL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-2461
Mailing Address - Country:US
Mailing Address - Phone:307-620-1507
Mailing Address - Fax:
Practice Address - Street 1:140 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1846
Practice Address - Country:US
Practice Address - Phone:307-620-1507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1139251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health