Basic Information
| Provider Information | |||||||||
| NPI: | 1861577322 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENTHAL | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2-9 PARK LN | ||||||||
| Address2: | |||||||||
| City: | DINOSAUR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816109725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357896300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1140 W 500 S | ||||||||
| Address2: | |||||||||
| City: | VERNAL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840782914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357896300 | ||||||||
| FaxNumber: | 4357896325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YP2500X | 5250168-6004 | UT | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.