Basic Information
| Provider Information | |||||||||
| NPI: | 1720064686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRAYER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CONRAD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 719 SO 22ND ST. | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077429809 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 255 N 30TH STREET | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077422141 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 12/11/2008 | ||||||||
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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 | 1041C0700X | 019 | WY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 019LCSW | WY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | MH75 | 01 | WY | WINHEALTH PARTNERS | OTHER | 307576 | 01 | WY | BS | OTHER | 8000014276 | 01 | WY | RR MEDICARE | OTHER |