MEDICARE: SPECIALTY COUNSELING & CONSULTING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	103T00000X	Psychologist
4	1041C0700X	Clinical Social Worker
5	106H00000X	Marriage & Family Therapist
6	251S00000X	Community/Behavioral Health Agency
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
8	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1982476370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY COUNSELING & CONSULTING

Provider Business Mailing Address
First Line	:	4025 RAWLINS ST
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-1900
Country	:	US
Telephone Number	:	307-426-4797
Fax Number	:	307-426-4799

Provider Business Practice Location Address
First Line	:	4006 CLEVELAND AVE
Second Line	:	BLDG B, STE 1
City	:	WELLINGTON
State	:	CO
Zip	:	80549-5056
Country	:	US
Telephone Number	:	307-459-3670
Fax Number	:	307-426-4799

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. ROBERT LOGAN
Credential	:	LPC
Telephone Number	:	307-426-4797

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	11/02/2023

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Directions to “SPECIALTY COUNSELING & CONSULTING ” Practice Location

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