Basic Information
| Provider Information | |||||||||
| NPI: | 1720100613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORDEN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | ANEIROS | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NCC LPC 1027 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 S 1ST STREET | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077429390 | ||||||||
| FaxNumber: | 3077429717 | ||||||||
| Practice Location | |||||||||
| Address1: | 217 S 1ST STREET | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077429390 | ||||||||
| FaxNumber: | 3077429717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 02/27/2008 | ||||||||
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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 | 1027 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.