Provider Demographics
NPI:1336123777
Name:RUBECK, SHERRI J (MA, LPC #539)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:J
Last Name:RUBECK
Suffix:
Gender:F
Credentials:MA, LPC #539
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 CENTRAL AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4557
Mailing Address - Country:US
Mailing Address - Phone:307-221-9791
Mailing Address - Fax:307-635-3965
Practice Address - Street 1:1620 CENTRAL AVE STE 302
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4557
Practice Address - Country:US
Practice Address - Phone:307-221-9791
Practice Address - Fax:307-635-3965
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY539101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311127OtherBS OF WY
WYMH124OtherHMO WINHEALTH PARTNERS