Provider Demographics
NPI:1780019240
Name:WYOMING ART THERAPY AND MEDICAL COUNSELING
Entity Type:Organization
Organization Name:WYOMING ART THERAPY AND MEDICAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MHR, ATR-BC, LPC, NC
Authorized Official - Phone:307-760-6125
Mailing Address - Street 1:920 E SHERIDAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3868
Mailing Address - Country:US
Mailing Address - Phone:307-760-6125
Mailing Address - Fax:
Practice Address - Street 1:920 E SHERIDAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3868
Practice Address - Country:US
Practice Address - Phone:307-760-6125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty