Healthcare Provider Details

I. General information

NPI: 1205345931
Provider Name (Legal Business Name): SOUTHWEST COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 ANKENY WAY
ROCK SPRINGS WY
82901-5649
US

IV. Provider business mailing address

2706 ANKENY WAY
ROCK SPRINGS WY
82901-5649
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA ACKER
Title or Position: CEO
Credential: MA, LPC
Phone: 307-352-6677