Provider Demographics
NPI:1194710996
Name:SALAS, MARTI RENEE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARTI
Middle Name:RENEE
Last Name:SALAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6918
Mailing Address - Country:US
Mailing Address - Phone:307-631-6901
Mailing Address - Fax:
Practice Address - Street 1:508 E 17TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4612
Practice Address - Country:US
Practice Address - Phone:307-631-6901
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-4451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical