Provider Demographics
NPI:1558486621
Name:WISEHART, DARCIE N (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DARCIE
Middle Name:N
Last Name:WISEHART
Suffix:
Gender:F
Credentials:MSW, LCSW
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 137
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-0137
Mailing Address - Country:US
Mailing Address - Phone:307-765-2112
Mailing Address - Fax:
Practice Address - Street 1:535 GREYBULL AVE
Practice Address - Street 2:
Practice Address - City:GREYBULL
Practice Address - State:WY
Practice Address - Zip Code:82426-2038
Practice Address - Country:US
Practice Address - Phone:307-765-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-5601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313582OtherBLUECROSS BLUESHIELD