Provider Demographics
NPI:1437370145
Name:DEMSHAR, JAMES W (LAT #258)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:DEMSHAR
Suffix:
Gender:M
Credentials:LAT #258
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 E FOX FARM RD
Mailing Address - Street 2:STE 1A
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2559
Mailing Address - Country:US
Mailing Address - Phone:307-635-3618
Mailing Address - Fax:307-635-1442
Practice Address - Street 1:4025 RAWLINS ST.
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-426-4797
Practice Address - Fax:307-426-4799
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYMA, LAT-258101YA0400X, 101YM0800X, 101Y00000X
WYLAT-258101YA0400X
WYMA,LAT#258101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY134759400Medicaid