Provider Demographics
NPI:1083850440
Name:VOLK, JEREMIAH ROBERT (LCSW-691)
Entity type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:ROBERT
Last Name:VOLK
Suffix:
Gender:M
Credentials:LCSW-691
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S WOLCOTT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2882
Mailing Address - Country:US
Mailing Address - Phone:307-333-5370
Mailing Address - Fax:307-333-5371
Practice Address - Street 1:500 S WOLCOTT ST STE 103
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2882
Practice Address - Country:US
Practice Address - Phone:307-333-5370
Practice Address - Fax:307-333-5371
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLAT-356261QR0405X
WYLCSW-6911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty