Provider Demographics
NPI:1346610193
Name:NEWKIRK-HORNECKER, JOLYNN L (MA,NCC,LPC)
Entity Type:Individual
Prefix:MS
First Name:JOLYNN
Middle Name:L
Last Name:NEWKIRK-HORNECKER
Suffix:
Gender:F
Credentials:MA,NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-0177
Mailing Address - Country:US
Mailing Address - Phone:307-789-3464
Mailing Address - Fax:307-789-7373
Practice Address - Street 1:831 HIGHWAY 150 S
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5340
Practice Address - Country:US
Practice Address - Phone:307-789-3464
Practice Address - Fax:307-789-7373
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional