Provider Demographics
NPI:1316106503
Name:KROTZ, KALYN K (MA, LPC)
Entity type:Individual
Prefix:
First Name:KALYN
Middle Name:K
Last Name:KROTZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KALYN
Other - Middle Name:K
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4025 RAWLINS ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1900
Mailing Address - Country:US
Mailing Address - Phone:304-426-4799
Mailing Address - Fax:
Practice Address - Street 1:975 GILCHRIST ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-2931
Practice Address - Country:US
Practice Address - Phone:307-222-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1120101Y00000X
WYLPC-1120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor