Healthcare Provider Details

I. General information

NPI: 1346844701
Provider Name (Legal Business Name): HALCYON COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 PIONEER AVE
CHEYENNE WY
82001-3024
US

IV. Provider business mailing address

2622 PIONEER AVE
CHEYENNE WY
82001-3024
US

V. Phone/Fax

Practice location:
  • Phone: 307-287-7685
  • Fax: 307-248-5600
Mailing address:
  • Phone: 307-287-7685
  • Fax: 307-248-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STACEY MARIE LANE
Title or Position: CEO
Credential: LCSW
Phone: 307-287-7685