Wild Roots Counseling Llc
LBN: Wild Roots Counseling Llc
Wild Roots Counseling Llc is an health care organization with primary practice located at 337 Robert St , Cody WY 82414-9268. The organization recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Mental Health is the primary health care specialty.
Wild Roots Counseling Llc can be contacted via phone (307) 899-2492, or through Moulton, Jamaica Santos via phone (307) 254-5048.
Contact Information
Primary practice address
337 Robert St
Cody WY 82414-9268
Phone: (307) 899-2492
Fax:
Website:
Authorized official contact:
Name: Moulton, Jamaica Santos Licensed Professional Counselor (LPC)
Phone: (307) 254-5048
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | ||
| Behavioral Health & Social Service Providers / Professional | 101YP2500X |
Profile Details
| NPI number | 1790484889 |
|---|---|
| LBN Legal business name | Wild Roots Counseling Llc |
| DBA Doing business as | |
| Authorized official | Moulton, Jamaica Santos Licensed Professional Counselor (LPC) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Feb 27th, 2023 |
| Last updated | May 28th, 2024 - about 7 months ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790484889 | NPPES |
| Wyoming | MEDICAID | 1326474156 |
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