Provider Demographics
NPI:1104091727
Name:SKAGGS, ROBERT M (LPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:SKAGGS, LPC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1587
Mailing Address - Street 2:420 S. JACKSON ST.
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1587
Mailing Address - Country:US
Mailing Address - Phone:307-413-6262
Mailing Address - Fax:307-733-7673
Practice Address - Street 1:420 S. JACKSON ST.
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-1587
Practice Address - Country:US
Practice Address - Phone:307-413-6262
Practice Address - Fax:307-733-7673
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY LPC#311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional