Provider Demographics
NPI:1023144201
Name:GATEWAY COUNSELING CENTER
Entity type:Organization
Organization Name:GATEWAY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:307-587-8889
Mailing Address - Street 1:18 JOHN WAYNE LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-9469
Mailing Address - Country:US
Mailing Address - Phone:307-272-8880
Mailing Address - Fax:
Practice Address - Street 1:1102 BECK AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3624
Practice Address - Country:US
Practice Address - Phone:307-587-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC352101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty