Provider Demographics
NPI:1205191541
Name:KRALL, ELIZA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZA
Middle Name:J
Last Name:KRALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ELIZA
Other - Middle Name:JEAN
Other - Last Name:SALWEI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 20092
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003
Mailing Address - Country:US
Mailing Address - Phone:307-772-1415
Mailing Address - Fax:970-522-4211
Practice Address - Street 1:1607 CAPITOL AVE FL THE2
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4525
Practice Address - Country:US
Practice Address - Phone:307-630-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WYWY8741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health