Provider Demographics
NPI:1467726513
Name:GEORGE, WENDY ANN (LPC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:WIKUM
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 788
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-0778
Mailing Address - Country:US
Mailing Address - Phone:307-575-8592
Mailing Address - Fax:307-688-5015
Practice Address - Street 1:110 W 22ND AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-7778
Practice Address - Country:US
Practice Address - Phone:307-575-8592
Practice Address - Fax:307-688-5015
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY653101YM0800X
WYLPC1397101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY132922700Medicare UPIN