Provider Demographics
NPI:1639328040
Name:ANNE C FITZGERALD, PHD, LLC
Entity Type:Organization
Organization Name:ANNE C FITZGERALD, PHD, LLC
Other - Org Name:ANNE C BUNN, PHD, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER-PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-399-7499
Mailing Address - Street 1:1465 N 4TH ST STE 113
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2066
Mailing Address - Country:US
Mailing Address - Phone:073-997-4993
Mailing Address - Fax:307-745-3221
Practice Address - Street 1:1465 N 4TH ST STE 113
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2066
Practice Address - Country:US
Practice Address - Phone:073-997-4993
Practice Address - Fax:307-745-3221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY308103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty