Healthcare Provider Details

I. General information

NPI: 1083448682
Provider Name (Legal Business Name): SOUTHWEST COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 ANKENY WAY
ROCK SPRINGS WY
82901-5649
US

IV. Provider business mailing address

2300 FOOTHILL BLVD
ROCK SPRINGS WY
82901-5610
US

V. Phone/Fax

Practice location:
  • Phone: 307-352-6677
  • Fax: 307-352-6614
Mailing address:
  • Phone: 307-352-6677
  • Fax: 307-352-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA JANAE WRAY-MARCHETTI
Title or Position: CFO
Credential:
Phone: 307-352-6677