Healthcare Provider Details

I. General information

NPI: 1790913523
Provider Name (Legal Business Name): TRANSITIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 4TH ST SUITE 18
GILLETTE WY
82716-4061
US

IV. Provider business mailing address

801 E 4TH ST SUITE 18
GILLETTE WY
82716-4061
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-8617
  • Fax: 307-682-8602
Mailing address:
  • Phone: 307-682-8617
  • Fax: 307-682-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAT 157
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 729
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 011
License Number StateWY

VIII. Authorized Official

Name: MRS. JOANNE ELAINE RISSER-HICKS
Title or Position: LICENSED PROF. COUNSELOR/PRESIDENT
Credential: MS, LPC, NCC
Phone: 307-682-8617