Provider Demographics
NPI:1497098172
Name:BIRTHING TRADITIONS, LLC
Entity Type:Organization
Organization Name:BIRTHING TRADITIONS, LLC
Other - Org Name:FORMERLY YOUR BIRTHRIGHT, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LENNON
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM, BSM
Authorized Official - Phone:307-202-2386
Mailing Address - Street 1:751 ROAD 11
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-9131
Mailing Address - Country:US
Mailing Address - Phone:307-202-2386
Mailing Address - Fax:
Practice Address - Street 1:751 ROAD 11
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-9131
Practice Address - Country:US
Practice Address - Phone:307-202-2386
Practice Address - Fax:307-754-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10176B00000X
261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY10OtherSTATE LICENSED MIDWIFE, LICENSE #10