| Doctor Name: | DR. VIVIAN GAY DEITRICH-MACLEAN |
| NPI Number: | 1003030511 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 291 |
| Business Practice Address: | 507 S 4th St Suite B Laramie, WY - 820703729 |
| Business Phone Number: | 3077551982 |
| Business Fax Number: | 3077424089 |
| Mailing Address: | 507 S 4th St, Suite B LARAMIE |
| State: | WY |
| Postal Code: | 820703729 |
| Phone Number: | 3077551982 |
| Fax Number: | |
| NPI Enumeration Date: | 04/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 291 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |