Provider Demographics
NPI:1275739500
Name:VANCE, KEVIN (LMFT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:VANCE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E LOUCKS ST UNIT 3014
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6428
Mailing Address - Country:US
Mailing Address - Phone:307-461-9619
Mailing Address - Fax:
Practice Address - Street 1:1949 SUGARLAND DR STE 180
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5720
Practice Address - Country:US
Practice Address - Phone:307-461-9619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLMFT-112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist