Provider Demographics
NPI:1710203526
Name:SHEREMETA, BRIAN D (LMFT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:SHEREMETA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 COFFEEN AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6206
Mailing Address - Country:US
Mailing Address - Phone:307-760-9148
Mailing Address - Fax:
Practice Address - Street 1:23 N SCOTT ST
Practice Address - Street 2:SUITE 18
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6336
Practice Address - Country:US
Practice Address - Phone:307-760-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0125106H00000X
WYLMFT0125101YM0800X, 101Y00000X, 101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional