Provider Demographics
NPI:1164726766
Name:MCLAUGHLIN, MARC DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:DOUGLAS
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0115
Mailing Address - Country:US
Mailing Address - Phone:307-463-0476
Mailing Address - Fax:855-304-2871
Practice Address - Street 1:205 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4349
Practice Address - Country:US
Practice Address - Phone:307-463-0476
Practice Address - Fax:855-304-2871
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical