Provider Demographics
NPI:1235333667
Name:WIRTA-LEIKER, CHAITRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHAITRA
Middle Name:
Last Name:WIRTA-LEIKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 AIRPORT PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1518
Mailing Address - Country:US
Mailing Address - Phone:307-632-7771
Mailing Address - Fax:
Practice Address - Street 1:1401 AIRPORT PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1518
Practice Address - Country:US
Practice Address - Phone:307-632-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY515103T00000X, 103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling