MEDICARE: TETON CREST COUNSELING LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871442566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TETON CREST COUNSELING LLC

Provider Business Mailing Address
First Line	:	1200 MELODY CREEK LN
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8982
Country	:	US
Telephone Number	:	307-413-8393
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 PIONEER LN STE 11
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8175
Country	:	US
Telephone Number	:	307-413-8393
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	PAIGE JOHNSTON
Credential	:	LPC
Telephone Number	:	307-413-8393

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	04/24/2026

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Directions to “TETON CREST COUNSELING LLC ” Practice Location

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