Provider Demographics
NPI:1508180217
Name:LIVING POSITIVELY ON PURPOSE PC
Entity Type:Organization
Organization Name:LIVING POSITIVELY ON PURPOSE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:COCKREHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-287-7847
Mailing Address - Street 1:507 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4617
Mailing Address - Country:US
Mailing Address - Phone:307-287-7847
Mailing Address - Fax:307-637-2377
Practice Address - Street 1:601 RANDALL AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2746
Practice Address - Country:US
Practice Address - Phone:307-287-7847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty