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General NPI Number Information
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NPI Number | 1477289205
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Entity Type | Organization
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Legal Business Name | TIMBERLINE COUNSELING LLC
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 1949 SUGARLAND DR STE 180
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City | SHERIDAN
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State | WY
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Zip | 82801-5720
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Country | US
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Telephone | 307-461-9619
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E LOUCKS ST UNIT 3014
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City | SHERIDAN
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State | WY
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Zip | 82801-6428
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Country | US
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Telephone | 307-461-9619
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEVIN VANCE
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Credential |
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Telephone | 307-461-9619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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