Provider Demographics
NPI:1033484118
Name:LIVING WELL COUNSELING LLC
Entity Type:Organization
Organization Name:LIVING WELL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC LAT
Authorized Official - Phone:307-235-3333
Mailing Address - Street 1:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82602-0552
Mailing Address - Country:US
Mailing Address - Phone:307-797-4683
Mailing Address - Fax:307-337-3705
Practice Address - Street 1:1301 S WISCONSIN AVE.
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2936
Practice Address - Country:US
Practice Address - Phone:307-472-5433
Practice Address - Fax:307-337-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC817101Y00000X
WYLAT286101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty