Basic Information
| Provider Information | |||||||||
| NPI: | 1427492883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORDOVA | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 E 18TH ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820015511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076337382 | ||||||||
| FaxNumber: | 3076337202 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 E 18TH ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820015511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076337382 | ||||||||
| FaxNumber: | 3076337202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2013 | ||||||||
| LastUpdateDate: | 04/29/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1349 | WY | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 6104 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.