Healthcare Provider Details

I. General information

NPI: 1932458734
Provider Name (Legal Business Name): A POSITIVE SOLUTION COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W LAKEWAY RD SUITE 1004
GILLETTE WY
82718-6361
US

IV. Provider business mailing address

201 W LAKEWAY RD SUITE 1004
GILLETTE WY
82718-6361
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-3747
  • Fax: 307-682-3748
Mailing address:
  • Phone: 307-682-3747
  • Fax: 307-682-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number516
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number462
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number170
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number386
License Number StateWY

VIII. Authorized Official

Name: MS. BONITA SUE MORISETTE
Title or Position: CLINICAL DIRECTOR
Credential: MSW, LCSW-462
Phone: 307-682-3747