Healthcare Provider Details

I. General information

NPI: 1659132264
Provider Name (Legal Business Name): FAMILY TO FAMILY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E 19TH ST STE 3
CHEYENNE WY
82001-4946
US

IV. Provider business mailing address

1616 E 19TH ST STE 3
CHEYENNE WY
82001-4946
US

V. Phone/Fax

Practice location:
  • Phone: 307-214-0229
  • Fax:
Mailing address:
  • Phone: 307-214-0229
  • Fax:

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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL LANE
Title or Position: OWNER
Credential:
Phone: 307-214-0229