Basic Information
| Provider Information | |||||||||
| NPI: | 1790783892 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYLET | ||||||||
| FirstName: | MONNIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MYLET | ||||||||
| OtherFirstName: | MONICA | ||||||||
| OtherMiddleName: | ANNE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 501 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 822401503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075324091 | ||||||||
| FaxNumber: | 3075328409 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 822401503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075324091 | ||||||||
| FaxNumber: | 3075328409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 05/13/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 179 | WY | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 312397 | 01 | WY | BS | OTHER |