Healthcare Provider Details

I. General information

NPI: 1639593080
Provider Name (Legal Business Name): CAPITOL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 THOMES AVE
CHEYENNE WY
82001-3527
US

IV. Provider business mailing address

1918 THOMES AVE
CHEYENNE WY
82001-3527
US

V. Phone/Fax

Practice location:
  • Phone: 307-631-5574
  • Fax: 307-514-5751
Mailing address:
  • Phone: 307-631-5574
  • Fax: 307-514-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-824
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-483
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-1425
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-575
License Number StateWY
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateWY

VIII. Authorized Official

Name: MR. SUSAN L. WRIEDT-BYRNE
Title or Position: PARTNER
Credential: MS,LPC, NCC
Phone: 307-631-5574