person
Mrs. Brenda Lavonne Jacob, MS,CCDCIII,LAT
Addiction (Substance Use Disorder) Counselor in Gillette, Wyoming
NPI 1780812214

Brenda Lavonne Jacob is an Addiction (Substance Use Disorder) Counselor based in Gillette, WY and is specialized in Addiction (Substance Use Disorder). Brenda Lavonne Jacob practices in Gillette, WY and has the professional credentials of MS,CCDCIII,LAT. The NPI Number for Brenda Lavonne Jacob is 1780812214 and holds a License No. LAT-270 (Wyoming).

The current practice location address for Brenda Lavonne Jacob is 113 S Gillette Ave, Gillette, WY and can be reached out via phone at 307-685-6982 and via fax at 307-685-8054. You can also correspond with Brenda Lavonne Jacob through the mailing address at 701 FAIRWAY DR, GILLETTE, WY - 82718-7605 (mailing address contact number: 307-689-0666).

Location: 113 S Gillette Ave, Gillette, WY, 82718-7605
person
Provider Profile Details
NPI Number
1780812214
Provider Name
Brenda Lavonne Jacob
Credential
MS,CCDCIII,LAT
Provider Entity Type
Individual
Gender
Female
Address
113 S Gillette Ave, Gillette, WY, 82718-7605
Phone Number
307-685-6982
Fax Number
307-685-8054
Provider Enumeration Date
06/23/2009
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
113 S Gillette Ave
City
State
Zip
82716-3740
Phone Number
307-685-6982
Fax Number
307-685-8054
person
Provider Business Mailing Address Details
Address
113 S Gillette Ave
City
State
Zip
82716-3740
Phone Number
307-685-6982
Fax Number
307-685-8054
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
LAT-270 (Wyoming)
Definition
Definition to come...
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