Healthcare Provider Details

I. General information

NPI: 1871934190
Provider Name (Legal Business Name): LIV IN-HOME COUNSELING AND CARE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 SILVER SPUR RD
CHEYENNE WY
82009-1206
US

IV. Provider business mailing address

PO BOX 20092
CHEYENNE WY
82003-7002
US

V. Phone/Fax

Practice location:
  • Phone: 307-221-5409
  • Fax:
Mailing address:
  • Phone: 307-221-5409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number663
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number663
License Number StateWY

VIII. Authorized Official

Name: EMILY ANN LOOS
Title or Position: OWNER/MEMBER
Credential: LCSW
Phone: 307-221-5409