Provider Demographics
NPI:1245786110
Name:HEALING TREE COUNSELING LLC
Entity Type:Organization
Organization Name:HEALING TREE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:CRUICKSHANK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-215-1204
Mailing Address - Street 1:135 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3722
Mailing Address - Country:US
Mailing Address - Phone:307-215-1204
Mailing Address - Fax:
Practice Address - Street 1:135 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3722
Practice Address - Country:US
Practice Address - Phone:307-215-1204
Practice Address - Fax:307-215-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1625101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY144332100Medicaid