Provider Demographics
NPI:1528765823
Name:THAYER, JOHN ALVORD
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALVORD
Last Name:THAYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 WEST 5TH STREET
Mailing Address - Street 2:BOX 629
Mailing Address - City:LUSK
Mailing Address - State:WY
Mailing Address - Zip Code:82225
Mailing Address - Country:US
Mailing Address - Phone:307-334-3793
Mailing Address - Fax:307-334-0126
Practice Address - Street 1:619 WEST 5TH STREET
Practice Address - Street 2:629
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225-0001
Practice Address - Country:US
Practice Address - Phone:307-334-2224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool