Healthcare Provider Details

I. General information

NPI: 1346299260
Provider Name (Legal Business Name): COUNSELING CONSULTING & MEDIATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date: 12/01/2006
Reactivation Date: 07/24/2007

III. Provider practice location address

2315 DUNN AVENUE
CHEYENNE WY
82001-3214
US

IV. Provider business mailing address

2315 DUNN AVENUE
CHEYENNE WY
82001-3214
US

V. Phone/Fax

Practice location:
  • Phone: 307-630-4688
  • Fax: 307-637-5011
Mailing address:
  • Phone: 307-630-4688
  • Fax: 307-637-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number422
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number410
License Number StateWY

VIII. Authorized Official

Name: JANICE ANN SCHAAD
Title or Position: PRESIDENT OWNER
Credential: LCSW
Phone: 307-630-4688