Provider Demographics
NPI:1437780178
Name:NEWBY, MICKIE (LMSW)
Entity Type:Individual
Prefix:
First Name:MICKIE
Middle Name:
Last Name:NEWBY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2299
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-2299
Mailing Address - Country:US
Mailing Address - Phone:307-699-4047
Mailing Address - Fax:
Practice Address - Street 1:1490 GREGORY LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9021
Practice Address - Country:US
Practice Address - Phone:307-699-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-36165104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker