Provider Demographics
NPI:1306444583
Name:ULTREIA COUNSELING, LLC
Entity type:Organization
Organization Name:ULTREIA COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:605-680-1878
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-0431
Mailing Address - Country:US
Mailing Address - Phone:970-986-6295
Mailing Address - Fax:
Practice Address - Street 1:615 N CUSTER ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3736
Practice Address - Country:US
Practice Address - Phone:970-986-6295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-11
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty