Provider Demographics
NPI:1538493598
Name:HART, ROXY (MS, LPC, NCSP, NCP)
Entity Type:Individual
Prefix:
First Name:ROXY
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MS, LPC, NCSP, NCP
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
Mailing Address - Street 2:SUITE #218
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5755
Mailing Address - Country:US
Mailing Address - Phone:307-674-8686
Mailing Address - Fax:307-674-1825
Practice Address - Street 1:1949 SUGARLAND DR
Practice Address - Street 2:SUITE #218
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5755
Practice Address - Country:US
Practice Address - Phone:307-674-8686
Practice Address - Fax:307-674-1825
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY552101Y00000X, 101YP2500X
WY14910103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool