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General NPI Number Information
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NPI Number | 1407236060
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Entity Type | Organization
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Legal Business Name | ALLIANCE CHRISTIAN COUNSELING, LLC
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 147 COOPER LN E
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City | CODY
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State | WY
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Zip | 82414-9233
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Country | US
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Telephone | 307-250-7522
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Fax |
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Provider Business Mailing Address
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Address Line | 27 JUSTICE LN
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City | CODY
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State | WY
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Zip | 82414-8253
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Country | US
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Telephone | 307-250-7522
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR, LPC
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Name | JESSICA ERICKSON
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Credential | MA, LPC
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Telephone | 307-250-7522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-1145
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-1145
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LPC-1145
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License Number State | WY
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PCSW-605
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License Number State | WY
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | PCSW-605
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License Number State | WY
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-1145
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License Number State | WY
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