Provider Demographics
NPI:1689902009
Name:UPLIFT COUNSELING & DEVELOPMENT
Entity Type:Organization
Organization Name:UPLIFT COUNSELING & DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-324-5899
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-0911
Mailing Address - Country:US
Mailing Address - Phone:307-324-5899
Mailing Address - Fax:307-324-2695
Practice Address - Street 1:501 W BUFFALO ST
Practice Address - Street 2:DOWNSTAIRS
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5622
Practice Address - Country:US
Practice Address - Phone:307-324-5899
Practice Address - Fax:307-324-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-905101YP2500X
WY4681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty