Provider Demographics
NPI:1598988636
Name:CONGER, DOROTHY R (LPC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:R
Last Name:CONGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:R
Other - Last Name:KENDALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:350 CITY VIEW DR
Mailing Address - Street 2:#302
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5327
Mailing Address - Country:US
Mailing Address - Phone:307-789-7915
Mailing Address - Fax:307-789-6009
Practice Address - Street 1:350 CITY VIEW DR
Practice Address - Street 2:#302
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5327
Practice Address - Country:US
Practice Address - Phone:307-789-7915
Practice Address - Fax:307-789-6009
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-481101YM0800X
WYLPC481101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106662500Medicaid
WY310047OtherBCBS OF WYOMING
WY106662500Medicaid