MEDICARE: BEHAVIORAL HEALTHCARE SERVICES, LLC

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	101Y00000X	Counselor
4	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1992660302
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	30 N GOULD ST STE N
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6317
Country	:	US
Telephone Number	:	475-288-8698
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N GOULD ST STE N
Second Line	:	CT
City	:	SHERIDAN
State	:	WY
Zip	:	82801-6317
Country	:	US
Telephone Number	:	475-288-8698
Fax Number	:

Authorized Official
Title or Position	:	LPC
Name	:	DIANE TOBIN
Credential	:	LPC
Telephone Number	:	475-288-8698

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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