Provider Demographics
NPI:1437689668
Name:MCCUNE, SAMUEL BROSSARD (LPC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BROSSARD
Last Name:MCCUNE
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 1:1949 SUGARLAND DR STE 221
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5766
Mailing Address - Country:US
Mailing Address - Phone:307-763-8121
Mailing Address - Fax:
Practice Address - Street 1:1949 SUGARLAND DR STE 221
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5766
Practice Address - Country:US
Practice Address - Phone:307-763-8121
Practice Address - Fax:307-673-5167
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1007101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor