Provider Demographics
NPI:1871745281
Name:LAIRD, DAMON JUSTIN (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:DAMON
Middle Name:JUSTIN
Last Name:LAIRD
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N FOREST DR # 7
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-1915
Mailing Address - Country:US
Mailing Address - Phone:307-315-8655
Mailing Address - Fax:307-333-0451
Practice Address - Street 1:300 N FOREST DR # 7
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-1915
Practice Address - Country:US
Practice Address - Phone:307-315-8655
Practice Address - Fax:307-333-0451
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical