Provider Demographics
NPI:1821457821
Name:COURAGE TO CHANGE COUNSELING LLC
Entity Type:Organization
Organization Name:COURAGE TO CHANGE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENAEYER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-622-8616
Mailing Address - Street 1:PO BOX 1964
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-1964
Mailing Address - Country:US
Mailing Address - Phone:307-622-8616
Mailing Address - Fax:307-363-4339
Practice Address - Street 1:113 S. GILLETTE AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716
Practice Address - Country:US
Practice Address - Phone:307-622-8616
Practice Address - Fax:307-363-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY716251S00000X
WYLPC716261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health