Provider Demographics
NPI:1992109441
Name:JINDRICK THOLL, CHRISTY LEE (LPC)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEE
Last Name:JINDRICK THOLL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:LEE
Other - Last Name:JINDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4155 LEGION LN STE 3
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-1945
Mailing Address - Country:US
Mailing Address - Phone:307-277-7214
Mailing Address - Fax:
Practice Address - Street 1:4155 LEGION LN STE 3
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-1945
Practice Address - Country:US
Practice Address - Phone:307-277-7214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional