Provider Demographics
NPI:1669592077
Name:BABCOCK, GARY HALLIDAY (BS, NCAC II, LAT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:HALLIDAY
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:BS, NCAC II, LAT
Other - Prefix:MR
Other - First Name:GARY
Other - Middle Name:H
Other - Last Name:BABCOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS, NCACII, LAT
Mailing Address - Street 1:208 W MAIN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:721 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5447
Practice Address - Country:US
Practice Address - Phone:307-324-7156
Practice Address - Fax:307-328-1651
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLAT173101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor