Provider Demographics
NPI:1396833695
Name:HOLISTIC COMMUNITY SERVICES-A DIFFERENT WAY
Entity Type:Organization
Organization Name:HOLISTIC COMMUNITY SERVICES-A DIFFERENT WAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/CO-DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANAYMIE
Authorized Official - Middle Name:KASMIRA
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:LAT,MAC,LPC
Authorized Official - Phone:307-655-2321
Mailing Address - Street 1:614 BROOKSIDE PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WY
Mailing Address - Zip Code:82836
Mailing Address - Country:US
Mailing Address - Phone:307-655-2321
Mailing Address - Fax:
Practice Address - Street 1:614 BROOKSIDE PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WY
Practice Address - Zip Code:82836
Practice Address - Country:US
Practice Address - Phone:307-655-2321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLAT #292; LPC #951101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty