Provider Demographics
NPI:1669529897
Name:CURTIS, GARY LEE (LCSW)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:CURTIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 DILLON DR
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2913
Mailing Address - Country:US
Mailing Address - Phone:307-330-5060
Mailing Address - Fax:307-335-9633
Practice Address - Street 1:267 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3127
Practice Address - Country:US
Practice Address - Phone:307-330-5060
Practice Address - Fax:307-335-9633
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY042Medicare UPIN