Provider Demographics
NPI:1477334860
Name:WYOMING SUBSTANCE ABUSE ASSESSMENTS LLC
Entity Type:Organization
Organization Name:WYOMING SUBSTANCE ABUSE ASSESSMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:330-449-5020
Mailing Address - Street 1:30 N GOULD ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6317
Mailing Address - Country:US
Mailing Address - Phone:330-449-5020
Mailing Address - Fax:330-595-4025
Practice Address - Street 1:30 N GOULD ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6317
Practice Address - Country:US
Practice Address - Phone:330-449-5020
Practice Address - Fax:330-595-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty