Healthcare Provider Details

I. General information

NPI: 1306534342
Provider Name (Legal Business Name): AERIE BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 05/06/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MILL STREET
PINEDALE WY
82941
US

IV. Provider business mailing address

PO BOX 2358 343 N. FREMONT AVE.
PINEDALE WY
82941-2358
US

V. Phone/Fax

Practice location:
  • Phone: 307-360-3306
  • Fax:
Mailing address:
  • Phone: 307-360-3306
  • Fax: 307-203-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: KARLY MAJHANOVICH
Title or Position: OWNER/BCBA
Credential: BCBA, LBA
Phone: 307-360-3306