MEDICARE: WYOMING COUNSELING SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	101YP2500X	Professional Counselor	WYOMING LPC #336	WY

General Provider Information

NPI Number	:	1497855225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYOMING COUNSELING SERVICES PC

Provider Business Mailing Address
First Line	:	902 N 8TH WEST
Second Line	:	PO BOX 1234
City	:	RIVERTON
State	:	WY
Zip	:	82501-2332
Country	:	US
Telephone Number	:	307-857-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 N 8TH WEST
Second Line	:
City	:	RIVERTON
State	:	WY
Zip	:	82501-2332
Country	:	US
Telephone Number	:	307-857-3111
Fax Number	:	307-857-3848

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JULIE A HOUSE
Credential	:	MA, LPC, NCC, CH
Telephone Number	:	307-857-3111

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	01/25/2021

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