Provider Demographics
NPI:1013492750
Name:LESUMA, REED (PCSW)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:
Last Name:LESUMA
Suffix:
Gender:M
Credentials:PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0376
Mailing Address - Country:US
Mailing Address - Phone:307-885-9883
Mailing Address - Fax:307-885-5206
Practice Address - Street 1:389 ADAMS ST.
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-0376
Practice Address - Country:US
Practice Address - Phone:307-885-9883
Practice Address - Fax:307-885-5206
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical