Provider Demographics
NPI:1184006876
Name:H.O.P.E. COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:H.O.P.E. COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOLTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-689-9090
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:ROZET
Mailing Address - State:WY
Mailing Address - Zip Code:82727-0227
Mailing Address - Country:US
Mailing Address - Phone:307-689-9090
Mailing Address - Fax:307-689-9090
Practice Address - Street 1:113 S GILLETTE AVE
Practice Address - Street 2:216
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3740
Practice Address - Country:US
Practice Address - Phone:307-689-9090
Practice Address - Fax:307-689-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1475305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1083985733OtherUNITED HEALTH
WY1083985733OtherKID CARE CHIP
WY1083985733OtherBLUE CROSS BLUE SHIELD OF WYOMING
WY1083985733Medicaid
WY1083985733OtherMERITAIN
WY1083985733OtherTRI-CARE
WY1083985733OtherAETNA
WY1083985733OtherCIGNA
WY1083985733OtherUBH
WY1083985733OtherUNHC
WY1083985733OtherIHC