Provider Demographics
NPI:1386825446
Name:DANA, KIPP (LPC)
Entity Type:Individual
Prefix:
First Name:KIPP
Middle Name:
Last Name:DANA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 NORTH SPRAGUE CREEK RD.
Mailing Address - Street 2:P.O BOX 24
Mailing Address - City:FAIRVIEW
Mailing Address - State:WY
Mailing Address - Zip Code:83119-0024
Mailing Address - Country:US
Mailing Address - Phone:307-723-2252
Mailing Address - Fax:
Practice Address - Street 1:389 ADAMS
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-0376
Practice Address - Country:US
Practice Address - Phone:307-885-9883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLAT-220101YA0400X
IDLCPC3048101YM0800X
WYLPC-550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health