Provider Demographics
NPI:1538486402
Name:FREMONT COUNSELING
Entity Type:Organization
Organization Name:FREMONT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-856-6587
Mailing Address - Street 1:1110 MAJOR AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2342
Mailing Address - Country:US
Mailing Address - Phone:307-856-6587
Mailing Address - Fax:
Practice Address - Street 1:1110 MAJOR AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2342
Practice Address - Country:US
Practice Address - Phone:307-856-6587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1147251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health