Deette Lundberg, LAT
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Casper, WY
NPI 1124650486 · NPPES record last updated Feb 5, 2020
Key facts
- NPI
- 1124650486
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- LAT-345 (WY)
- Practice address
- 231 S Wilson St
Casper, WY 82601-2941 - Phone
- (307) 265-3791
- Fax
- (307) 265-4480
- NPI assigned
- Feb 5, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240311000825 | WY | Practitioner - Mental Health Counselor | 0446696629 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wyoming Recovery Rawlins | Current |
Accepting new patients | |
| S48Wy1, LLC | Current |
Accepting new patients |
Locations
231 S Wilson St
Casper, WY 82601
Phone (307) 265-3791
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LAT-345 | WY | Yes |
Addresses
Primary practice location
231 S Wilson St
Casper, WY 82601-2941
Mailing address
231 S Wilson St
Casper, WY 82601-2941
Phone (307) 265-3791
Other providers in Casper, WY
- Lsref Golden Ops 14 (Wy) LLC
- Marko Lubardic
- Frances Lee Lujan
- Netsanet Lundahl
- Lundberg Consultant Services PC
- Sophia Lybrand
- DJ Lyles
- Laurie Ann Lyon
- Rebecca Mabie
- Anne M Macguire
All providers in Casper, WY · Addiction (Substance Use Disorder) Counselor in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.