Provider Demographics
NPI:1952706822
Name:SWEETWATER COUNSELING
Entity Type:Organization
Organization Name:SWEETWATER COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-337-3797
Mailing Address - Street 1:3211 ENERGY LN STE 402
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-2963
Mailing Address - Country:US
Mailing Address - Phone:307-337-3797
Mailing Address - Fax:307-337-3797
Practice Address - Street 1:3211 ENERGY LN STE 402
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-2963
Practice Address - Country:US
Practice Address - Phone:307-337-3797
Practice Address - Fax:307-337-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1248101YP2500X
WY1368101YP2500X
WY560101YP2500X
WY151106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty