Healthcare Provider Details

I. General information

NPI: 1457262461
Provider Name (Legal Business Name): BLACK SHEPHERD COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E 1ST ST
GILLETTE WY
82716-3801
US

IV. Provider business mailing address

910 E 4TH ST
GILLETTE WY
82716-4035
US

V. Phone/Fax

Practice location:
  • Phone: 307-670-1656
  • Fax:
Mailing address:
  • Phone: 307-670-1656
  • 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: MS. CHERYL TREMBATH
Title or Position: OWNER
Credential: MS LPC
Phone: 307-670-1656