Healthcare Provider Details

I. General information

NPI: 1609417088
Provider Name (Legal Business Name): VALLEY COUNSELING & COACHING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S MAIN ST STE F
LYMAN WY
82937-5112
US

IV. Provider business mailing address

PO BOX 741
LYMAN WY
82937-0741
US

V. Phone/Fax

Practice location:
  • Phone: 208-360-6271
  • Fax:
Mailing address:
  • Phone: 208-360-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN ANDERSON
Title or Position: PRESIDENT
Credential: LCSW
Phone: 208-360-6271