Archie Maurice Pettry III, M.S.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC-1522 Issued in WY

Practice address

701 Antler Dr Ste 110
Casper, WY 82601-1747

Phone

(307) 466-8008

NPI assigned

May 20, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1369008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1821434622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 ANTLER DR STE 110",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826011747",
            "telephone_number": "307-466-8008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 ANTLER DR STE 110",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826011747",
            "telephone_number": "307-466-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTRY",
        "first_name": "ARCHIE",
        "middle_name": "MAURICE",
        "name_suffix": "III",
        "credential": "M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-05-20",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WY",
            "license": "LPC-1522",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "WY",
            "license": "LPC-1522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roberta A Peters, RN
• Mary Petersen
• Jacob Dean Peterson, DDS
• Jessica Ann Peterson, CPNP-PC
• Robert Lee Peterson, PSY.D.
• Ashleigh Carolyn Petty
• Pharmaceutical Compounding Specialists of Wyoming
• Pharmacy Solutions Inc
• Pharmworx LLC (Medicap - Casper, WY)
• Ilene J Phillips, R.N.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.