| Doctor Name: | WILMA LARVIE |
| NPI Number: | 1407175516 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LAT |
| License Number: | WYLAT-174 |
| Business Practice Address: | 28 Black Cole Fort Washakie, WY - 825140638 |
| Business Phone Number: | 3073324758 |
| Business Fax Number: | 3073358108 |
| Mailing Address: | Po Box 638, FORT WASHAKIE |
| State: | WY |
| Postal Code: | 825140638 |
| Phone Number: | 3073324758 |
| Fax Number: | 3073358108 |
| NPI Enumeration Date: | 05/28/2010 |
| NPI Last Update Date: | 05/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | WYLAT-174 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |