Doctor Name: | KIMBERLY K DYER |
NPI Number: | 1164709697 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PPC |
License Number: | PPC-575 |
Business Practice Address: | 1560 Johnston St Suite E Wheatland, WY - 822013216 |
Business Phone Number: | 3073223346 |
Business Fax Number: | |
Mailing Address: | 1560 Johnston St, Suite E WHEATLAND |
State: | WY |
Postal Code: | 822013216 |
Phone Number: | 3073223346 |
Fax Number: | |
NPI Enumeration Date: | 11/11/2011 |
NPI Last Update Date: | 11/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | PPC-575 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |