Healthcare Provider Details

I. General information

NPI: 1386915528
Provider Name (Legal Business Name): ROCKY MOUNTAIN BEHAVIORAL HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E 3RD ST STE 102
CASPER WY
82601-3200
US

IV. Provider business mailing address

301 THELMA DR STE 226
CASPER WY
82609
US

V. Phone/Fax

Practice location:
  • Phone: 307-462-4876
  • Fax: 307-337-3492
Mailing address:
  • Phone: 405-412-5468
  • Fax: 307-577-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRANDON WARDELL
Title or Position: PRESIDENT
Credential: DBH, MAMFT, NCC, LPC
Phone: 405-412-5468