Provider Demographics
NPI:1952648164
Name:CHILDRENS PLACE COUNSELING AND CONSULTATION LLC
Entity Type:Organization
Organization Name:CHILDRENS PLACE COUNSELING AND CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DONNINI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-235-3333
Mailing Address - Street 1:1300 E A ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2260
Mailing Address - Country:US
Mailing Address - Phone:307-235-3333
Mailing Address - Fax:
Practice Address - Street 1:1300 E A ST STE 201
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2260
Practice Address - Country:US
Practice Address - Phone:307-235-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW 6581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty