Provider Demographics
NPI:1700409927
Name:BRASMER, FANTASIA MARIE (PPC)
Entity Type:Individual
Prefix:
First Name:FANTASIA
Middle Name:MARIE
Last Name:BRASMER
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 WILKINS CIR, CASPER, WY 82601
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3443
Mailing Address - Country:US
Mailing Address - Phone:307-253-9067
Mailing Address - Fax:
Practice Address - Street 1:1430 WILKINS CIR, CASPER, WY 82601
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-247-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional