Provider Demographics
NPI:1992704464
Name:BANNON, TRISHA G (MS, LPC)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:G
Last Name:BANNON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 OXFORD DR
Mailing Address - Street 2:APT. 1
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1690
Mailing Address - Country:US
Mailing Address - Phone:307-640-2762
Mailing Address - Fax:
Practice Address - Street 1:1725 OXFORD DR
Practice Address - Street 2:APT. 1
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1690
Practice Address - Country:US
Practice Address - Phone:307-640-2762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional