Basic Information
| Provider Information | |||||||||
| NPI: | 1417027996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REEDY | ||||||||
| FirstName: | ROMMEL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M. DIV. LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2310 E 8TH ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820015256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076326433 | ||||||||
| FaxNumber: | 3076357982 | ||||||||
| Practice Location | |||||||||
| Address1: | 2310 E 8TH ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820015256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076326433 | ||||||||
| FaxNumber: | 3076357982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 12/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 503 | WY | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | LPC-503 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.