Healthcare Provider Details

I. General information

NPI: 1871468199
Provider Name (Legal Business Name): MOMENTUM THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 VAL VISTA ST STE 107
SHERIDAN WY
82801-3655
US

IV. Provider business mailing address

PO BOX 491
BIG HORN WY
82833-0491
US

V. Phone/Fax

Practice location:
  • Phone: 307-213-9964
  • Fax:
Mailing address:
  • Phone: 307-213-9964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARA D MONE
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 310-339-2856