Provider Demographics
NPI:1992488241
Name:LAWSON, DOREEN MCCULLOUGH (LPC-P)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:MCCULLOUGH
Last Name:LAWSON
Suffix:
Gender:F
Credentials:LPC-P
Other - Prefix:
Other - First Name:DORIE
Other - Middle Name:
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-P
Mailing Address - Street 1:PO BOX 6642
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-7102
Mailing Address - Country:US
Mailing Address - Phone:512-627-2888
Mailing Address - Fax:
Practice Address - Street 1:2161 COFFEEN AVE FL 4
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5754
Practice Address - Country:US
Practice Address - Phone:307-675-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health