MEDICARE: TAKE TIME COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LAT 269	WY
2	101YM0800X	Mental Health Counselor	LPC 732	WY
3	251S00000X	Community/Behavioral Health Agency	LPC 732	WY
4	251S00000X	Community/Behavioral Health Agency	LAT 269	WY
5	101YP2500X	Professional Counselor	LPC 732	WY

General Provider Information

NPI Number	:	1396162046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKE TIME COUNSELING

Provider Business Mailing Address
First Line	:	PO BOX 1375
Second Line	:
City	:	EVANSVILLE
State	:	WY
Zip	:	82636-1375
Country	:	US
Telephone Number	:	307-262-2787
Fax Number	:	307-234-9989

Provider Business Practice Location Address
First Line	:	2510 E 15TH ST
Second Line	:	SUITE11
City	:	CASPER
State	:	WY
Zip	:	82609-4111
Country	:	US
Telephone Number	:	307-262-2787
Fax Number	:	307-234-9989

Authorized Official
Title or Position	:	OWNER/CLINICAL THERAPIST
Name	:	MS. KIMBERLY ANN FAILES
Credential	:	MS LPC LAT
Telephone Number	:	307-262-2787

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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Directions to “TAKE TIME COUNSELING ” Practice Location

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