Healthcare Provider Details

I. General information

NPI: 1568721298
Provider Name (Legal Business Name): LS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 EDINBURGH ST
RAWLINS WY
82301-4506
US

IV. Provider business mailing address

596 ASH CT
KAMAS UT
84036-9275
US

V. Phone/Fax

Practice location:
  • Phone: 307-324-8820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1149
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1149
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1149
License Number StateWY

VIII. Authorized Official

Name: LIZA SANDERSON
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 435-640-3138