Healthcare Provider Details

I. General information

NPI: 1902730625
Provider Name (Legal Business Name): TRAILHEAD THERAPY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 FRONT ST STE 516
EVANSTON WY
82930-3567
US

IV. Provider business mailing address

724 FRONT ST STE 516
EVANSTON WY
82930-3567
US

V. Phone/Fax

Practice location:
  • Phone: 307-288-0066
  • Fax:
Mailing address:
  • Phone: 307-288-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRET MCCOY
Title or Position: ORGANIZER/MEMBER
Credential: LCSW
Phone: 307-288-0066