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Mrs. Cassidy Diane Provo, PPC
Professional Counselor in Casper, Wyoming
NPI 1942851019

Cassidy Diane Provo is a Professional Counselor based in Casper, WY and is specialized in Professional. Cassidy Diane Provo practices in Casper, WY and has the professional credentials of PPC. The NPI Number for Cassidy Diane Provo is 1942851019 and holds a License No. 1151 (Wyoming).

The current practice location address for Cassidy Diane Provo is 2241 Farnum St Ste 102, Casper, WY and can be reached out via phone at 307-234-9979 and via fax at 307-234-9989.

Location: 2241 Farnum St Ste 102, Casper, WY, 82609-4108
person
Provider Profile Details
NPI Number
1942851019
Provider Name
Cassidy Diane Provo
Credential
PPC
Provider Entity Type
Individual
Gender
Female
Address
2241 Farnum St Ste 102, Casper, WY, 82609-4108
Phone Number
307-234-9979
Fax Number
307-234-9989
Provider Enumeration Date
09/20/2019
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1295286185 05 WY
institution
Provider Business Practice Location Address Details
Address
2241 Farnum St Ste 102
City
State
Zip
82609-4108
Phone Number
307-234-9979
Fax Number
307-234-9989
person
Provider Business Mailing Address Details
Address
2241 Farnum St Ste 102
City
State
Zip
82609-4108
Phone Number
307-234-9979
Fax Number
307-234-9989
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
1151 (Wyoming)
Definition
Definition to come...
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