Provider Demographics
NPI:1417285883
Name:IRVINE, DARWIN L (MA, LPC, LAT)
Entity type:Individual
Prefix:MR
First Name:DARWIN
Middle Name:L
Last Name:IRVINE
Suffix:
Gender:M
Credentials:MA, LPC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:GREYBULL
Mailing Address - State:WY
Mailing Address - Zip Code:82426-0351
Mailing Address - Country:US
Mailing Address - Phone:307-568-2020
Mailing Address - Fax:
Practice Address - Street 1:116 S 3RD ST
Practice Address - Street 2:
Practice Address - City:BASIN
Practice Address - State:WY
Practice Address - Zip Code:82410
Practice Address - Country:US
Practice Address - Phone:307-568-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY172101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)