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General NPI Number Information
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NPI Number | 1447673082
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Entity Type | Organization
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Legal Business Name | KROSS FIRE COUNSELING & EQUINE ENTERPRISES
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Dates
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Enumeration Date | 02/03/2014
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 919 AIRPORT RD
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City | SHERIDAN
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State | WY
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Zip | 82801-5806
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Country | US
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Telephone | 307-751-3769
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Fax | 307-763-4440
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Provider Business Mailing Address
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Address Line | 919 AIRPORT RD
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City | SHERIDAN
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State | WY
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Zip | 82801-5806
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Country | US
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Telephone | 307-751-3769
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Fax | 307-763-4440
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Authorized Official
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Title or Position | CLINICIAN
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Name | KRYSTAL RALEY MA RALEY
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Credential | MA LPC
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Telephone | 307-751-3769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1076
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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 | 1076
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1076
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License Number State | WY
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