Provider Demographics
NPI:1417234980
Name:FLANERY WILSON, CYNTHIA ANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:FLANERY WILSON
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 1:310 S MILLER AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3944
Mailing Address - Country:US
Mailing Address - Phone:307-686-1189
Mailing Address - Fax:307-682-8649
Practice Address - Street 1:310 S MILLER AVE
Practice Address - Street 2:SUITE G
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3944
Practice Address - Country:US
Practice Address - Phone:307-686-1189
Practice Address - Fax:307-682-8649
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC1176101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional