| Doctor Name: | KIPP DANA |
| NPI Number: | 1386825446 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | LAT-220 |
| Business Practice Address: | 389 Adams Afton, WY - 831100376 |
| Business Phone Number: | 3078859883 |
| Business Fax Number: | |
| Mailing Address: | 404 North Sprague Creek Rd., P.o Box 24 FAIRVIEW |
| State: | WY |
| Postal Code: | 831190024 |
| Phone Number: | 3077232252 |
| Fax Number: | |
| NPI Enumeration Date: | 11/16/2007 |
| NPI Last Update Date: | 12/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LAT-220 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |