Provider Demographics
NPI:1366683013
Name:SISCO, JANA KAY (LPC)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:KAY
Last Name:SISCO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WERNER CT STE 300
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1325
Mailing Address - Country:US
Mailing Address - Phone:307-277-6473
Mailing Address - Fax:
Practice Address - Street 1:800 WERNER CT STE 300
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1325
Practice Address - Country:US
Practice Address - Phone:307-277-6473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008019428101YP2500X
WYLPC-1509101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional