Healthcare Provider Details

I. General information

NPI: 1497939524
Provider Name (Legal Business Name): SOAR COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 TAPADERO LN
CODY WY
82414-9622
US

IV. Provider business mailing address

14 TAPADERO LN
CODY WY
82414-9622
US

V. Phone/Fax

Practice location:
  • Phone: 307-250-1338
  • Fax:
Mailing address:
  • Phone: 307-250-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHERI MARIE KREITZMANN
Title or Position: OWNER
Credential:
Phone: 307-250-1338