Provider Demographics
NPI:1548703150
Name:WORTHAM, LINDSAY (MA, CAC II, LPCC)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:WORTHAM
Suffix:
Gender:F
Credentials:MA, CAC II, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2420
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82073
Mailing Address - Country:US
Mailing Address - Phone:307-223-1048
Mailing Address - Fax:
Practice Address - Street 1:2020 GRAND AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070
Practice Address - Country:US
Practice Address - Phone:307-223-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0008061101YA0400X
COLPCC.0014385101YM0800X
COLPC.0013596101YP2500X
WYLPC1835101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health