Provider Demographics
NPI:1629521547
Name:HATTERVIG, MAUREEN (MS LPC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:HATTERVIG
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 HILL POND DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2120
Mailing Address - Country:US
Mailing Address - Phone:307-751-0586
Mailing Address - Fax:
Practice Address - Street 1:52 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-4245
Practice Address - Country:US
Practice Address - Phone:307-751-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1689101YM0800X, 101Y00000X
101YM0800X, 101YP2500X
WYPPC-903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor