Provider Demographics
NPI:1164783916
Name:SPECIALTY COUNSELING
Entity Type:Organization
Organization Name:SPECIALTY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELING
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COWPER
Authorized Official - Suffix:
Authorized Official - Credentials:MS/PPC
Authorized Official - Phone:307-399-0575
Mailing Address - Street 1:4025 RAWLINS ST.
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001
Mailing Address - Country:US
Mailing Address - Phone:307-424-7986
Mailing Address - Fax:307-426-4799
Practice Address - Street 1:4025 RAWLINS ST.
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-424-7986
Practice Address - Fax:307-426-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-581251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY2CF879B33DMedicaid