Basic Information
Provider Information
NPI: 1396191151
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARBOUR
FirstName: TOMI
MiddleName: LEIGH
NamePrefix: MS.
NameSuffix:  
Credential: MA, LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HOBLIT
OtherFirstName: TOMI
OtherMiddleName: LEIGH
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1401 W 2ND ST
Address2: SUITE 1
City: GILLETTE
State: WY
PostalCode: 827163333
CountryCode: US
TelephoneNumber: 3076826699
FaxNumber:  
Practice Location
Address1: 1401 W 2ND ST
Address2: SUITE 1
City: GILLETTE
State: WY
PostalCode: 827163333
CountryCode: US
TelephoneNumber: 3076826699
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/11/2016
LastUpdateDate: 05/11/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X1570WYY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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