Active NPI
David Demorest, LPC(WYOMING 1288)
- Counselor
- Jackson, WY
National Provider Identifier
1841541679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LPC 1288
- Practice address
- 7520 Porcupine Creek Rd
Jackson, WY 83001 - Phone
- (307) 259-1865
- Fax
- (307) 200-0290
- NPI assigned
- Sep 19, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LPC 1288 | WY | Primary |
Addresses
Primary practice location
7520 Porcupine Creek Rd
Jackson, WY 83001
Mailing address
P.O Box 11390
610 W Broadway,
Jackson, WY 83002
Phone (307) 734-0017
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC 1288 | WY | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355875200000",
"number": "1841541679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O BOX 11390",
"address_2": "610 W BROADWAY,",
"city": "JACKSON",
"state": "WY",
"postal_code": "83002",
"telephone_number": "307-734-0017",
"fax_number": "307-200-0290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7520 PORCUPINE CREEK RD",
"city": "JACKSON",
"state": "WY",
"postal_code": "83001",
"telephone_number": "307-259-1865",
"fax_number": "307-200-0290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMOREST",
"first_name": "DAVID",
"credential": "LPC(WYOMING 1288)",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-19",
"last_updated": "2012-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WY",
"license": "LPC 1288",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.