Provider Demographics
NPI:1134661812
Name:FUGLSANG, COREY (BA)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:FUGLSANG
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LANE LN
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-8630
Mailing Address - Country:US
Mailing Address - Phone:307-675-4100
Mailing Address - Fax:
Practice Address - Street 1:5 LANE LN
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-8630
Practice Address - Country:US
Practice Address - Phone:307-675-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor