Provider Demographics
NPI:1376835041
Name:WINTERHOLLER, KATHRYN GLEN (LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GLEN
Last Name:WINTERHOLLER
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 1:67 QUEBEC AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-9613
Mailing Address - Country:US
Mailing Address - Phone:307-431-2080
Mailing Address - Fax:
Practice Address - Street 1:67 QUEBEC AVE
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-9613
Practice Address - Country:US
Practice Address - Phone:307-431-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1559101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor