Healthcare Provider Details

I. General information

NPI: 1114854924
Provider Name (Legal Business Name): POWDER RIVER COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WARREN AVE
GILLETTE WY
82716-3728
US

IV. Provider business mailing address

100 WARREN AVE
GILLETTE WY
82716-3728
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-2034
  • Fax: 307-682-2968
Mailing address:
  • Phone: 307-682-2034
  • Fax: 307-682-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA LESLIE
Title or Position: OWNER
Credential: DBH, LBA, LMFT
Phone: 949-922-3043