MEDICARE: WEVOLVE COUNSELING, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1669095204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEVOLVE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1471 DEWAR DR STE 232
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5885
Country	:	US
Telephone Number	:	307-352-9161
Fax Number	:

Provider Business Practice Location Address
First Line	:	1471 DEWAR DR STE 232
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5885
Country	:	US
Telephone Number	:	307-352-9161
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BETHANY ARMSTRONG
Credential	:	LPC
Telephone Number	:	307-352-9161

Provider Enumeration Date	:	05/18/2020
Last Update Date	:	10/18/2022

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