Doctor Name: | MS. BRENDA CATHERINE KOFFORD |
NPI Number: | 1902806383 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 741 |
Business Practice Address: | 1954 W Mariposa Pkwy Wheatland, WY - 822013102 |
Business Phone Number: | 3073223190 |
Business Fax Number: | 3073223198 |
Mailing Address: | 403 9th St, WHEATLAND |
State: | WY |
Postal Code: | 822012909 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/27/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 741 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |