Provider Demographics
NPI:1619227444
Name:FOUNDATIONS COUNSELING & CONSULTING OF WYOMING, LLC
Entity Type:Organization
Organization Name:FOUNDATIONS COUNSELING & CONSULTING OF WYOMING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:307-638-4092
Mailing Address - Street 1:2003 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3745
Mailing Address - Country:US
Mailing Address - Phone:307-638-4092
Mailing Address - Fax:307-635-3967
Practice Address - Street 1:2003 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3745
Practice Address - Country:US
Practice Address - Phone:307-638-4092
Practice Address - Fax:307-635-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1388101YP2500X
WY1352101YP2500X
WY1296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty