Provider Demographics
NPI:1255466736
Name:SORENSEN, BETTY JEAN (MS,MED,LPC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:JEAN
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:MS,MED,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PHEASANT RUN DR
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-9784
Mailing Address - Country:US
Mailing Address - Phone:307-332-3731
Mailing Address - Fax:
Practice Address - Street 1:315 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520
Practice Address - Country:US
Practice Address - Phone:307-332-4515
Practice Address - Fax:307-332-4899
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY242 LPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional