Active NPI
Alex Dimitrijevic, M.A.
- Mental Health Counselor
- Laramie, WY
National Provider Identifier
1932273794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC-1754
- Practice address
- 502 S 4TH St
Laramie, WY 82070-3704 - Phone
- (307) 755-1000
- Fax
- (307) 742-9717
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-1754 | WY | MD | Mental Health Counselor |
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC-1754 | WY | Primary |
Addresses
Primary practice location
502 S 4TH St
Laramie, WY 82070-3704
Mailing address
502 S 4TH St
Laramie, WY 82070-3704
Phone (307) 755-1000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 314626 | Other | WY | BLUE CROSS BLUE SHEILD |
NPI Registry JSON
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550707200000",
"number": "1932273794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "502 S 4TH ST",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820703704",
"telephone_number": "307-755-1000",
"fax_number": "307-742-9717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "502 S 4TH ST",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820703704",
"telephone_number": "307-755-1000",
"fax_number": "307-742-9717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIMITRIJEVIC",
"first_name": "ALEX",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2019-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WY",
"license": "LPC-1754",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHEILD",
"identifier": "314626",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Laramie, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.