Provider Demographics
NPI:1356411995
Name:DILTS-HARRYMAN, STACIE M (LPC, NCC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:M
Last Name:DILTS-HARRYMAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 ENGLISH DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1627
Mailing Address - Country:US
Mailing Address - Phone:307-259-3849
Mailing Address - Fax:307-235-1654
Practice Address - Street 1:735 ENGLISH DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1627
Practice Address - Country:US
Practice Address - Phone:307-259-3849
Practice Address - Fax:307-235-1654
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC948101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional