Active NPI
Dusty Pack, LPC
- Professional Counselor
- Sheridan, WY
National Provider Identifier
1881100519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-1702
- Practice address
- 1898 Fort Rd
Sheridan, WY 82801-8320 - Phone
- (307) 675-3891
- NPI assigned
- Dec 18, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-1702 | WY | Primary |
Addresses
Primary practice location
1898 Fort Rd
Sheridan, WY 82801-8320
Mailing address
1417 Spaulding St
Sheridan, WY 82801-2640
Phone (307) 751-4235
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-1702 | WY | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513555200000",
"number": "1881100519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1417 SPAULDING ST",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "828012640",
"telephone_number": "307-751-4235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1898 FORT RD",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "828018320",
"telephone_number": "307-675-3891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACK",
"first_name": "DUSTY",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-18",
"last_updated": "2017-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WY",
"license": "LPC-1702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sheridan, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.