Provider Demographics
NPI:1346299260
Name:COUNSELING CONSULTING & MEDIATION LLC
Entity Type:Organization
Organization Name:COUNSELING CONSULTING & MEDIATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHAAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-630-4688
Mailing Address - Street 1:2315 DUNN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3214
Mailing Address - Country:US
Mailing Address - Phone:307-630-4688
Mailing Address - Fax:307-637-5011
Practice Address - Street 1:2315 DUNN AVENUE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3214
Practice Address - Country:US
Practice Address - Phone:307-630-4688
Practice Address - Fax:307-637-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-07-24
Deactivation Date:2006-12-01
Deactivation Code:
Reactivation Date:2007-07-24
Provider Licenses
StateLicense IDTaxonomies
WY422103TC0700X
WY410104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20772Medicare UPIN
WY20771Medicare PIN