Provider Demographics
NPI:1932820347
Name:LINNAEA D. SUTPHIN, LLC
Entity type:Organization
Organization Name:LINNAEA D. SUTPHIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:LINNAEA
Authorized Official - Middle Name:DESPAIN
Authorized Official - Last Name:SUTPHIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-996-7964
Mailing Address - Street 1:2297 CARINA CT
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-9757
Mailing Address - Country:US
Mailing Address - Phone:307-996-7964
Mailing Address - Fax:
Practice Address - Street 1:109 E 17TH ST STE 210
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4543
Practice Address - Country:US
Practice Address - Phone:307-996-7964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty