Basic Information
| Provider Information | |||||||||
| NPI: | 1568613511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LING-CROFT | ||||||||
| FirstName: | DE'BURAE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 876 | ||||||||
| Address2: | |||||||||
| City: | PRICE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 845010876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356139500 | ||||||||
| FaxNumber: | 4356139414 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | LANDER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 825202736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073329577 | ||||||||
| FaxNumber: | 8013323106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2008 | ||||||||
| LastUpdateDate: | 10/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | WY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.