Trevor Pederson, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-1699 Issued in WY

Practice address

217 E Grand Ave Unit 5
Laramie, WY 82070-3604

Phone

(216) 217-7239

NPI assigned

Aug 25, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1408924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1689074833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2476",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820032476",
            "telephone_number": "307-638-0300",
            "fax_number": "307-638-0394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 E GRAND AVE UNIT 5",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820703604",
            "telephone_number": "216-217-7239"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1430 Wilkins Cir",
            "address_purpose": "LOCATION",
            "city": "Casper",
            "state": "WY",
            "postal_code": "826011336",
            "country_code": "US",
            "telephone_number": "307-237-9583",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "502 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Laramie",
            "state": "WY",
            "postal_code": "82070",
            "country_code": "US",
            "telephone_number": "307-755-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "TREVOR",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-25",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WY",
            "license": "LPC-1699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Laramie, WY
• Providers in Laramie, WY by specialty
• Professional Counselor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.