Provider Demographics
NPI:1669599619
Name:LEUGERS, RAYMOND G (PSY D)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:G
Last Name:LEUGERS
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W LOUCKS ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-4128
Mailing Address - Country:US
Mailing Address - Phone:307-672-2468
Mailing Address - Fax:307-672-2469
Practice Address - Street 1:425 W LOUCKS ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-4128
Practice Address - Country:US
Practice Address - Phone:307-672-2468
Practice Address - Fax:307-672-2469
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY109103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW9582Medicare ID - Type Unspecified
WYR63939Medicare UPIN