Provider Demographics
NPI:1043743388
Name:EMOTIONAL WELLNESS COUNSELING LLC
Entity Type:Organization
Organization Name:EMOTIONAL WELLNESS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-267-1681
Mailing Address - Street 1:6548 BOOT HILL RD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-9303
Mailing Address - Country:US
Mailing Address - Phone:307-267-1681
Mailing Address - Fax:
Practice Address - Street 1:6548 BOOT HILL RD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-9303
Practice Address - Country:US
Practice Address - Phone:307-267-1681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-10381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1194266833OtherINDIVIDUAL