1184006876 NPI number — H.O.P.E. COUNSELING SERVICES LLC

Table of content: (NPI 1184006876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184006876 NPI number — H.O.P.E. COUNSELING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H.O.P.E. COUNSELING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184006876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 227
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROZET
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82727-0227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-689-9090
Provider Business Mailing Address Fax Number:
307-689-9090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 S GILLETTE AVE
Provider Second Line Business Practice Location Address:
216
Provider Business Practice Location Address City Name:
GILLETTE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82716-3740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-689-9090
Provider Business Practice Location Address Fax Number:
307-689-9090
Provider Enumeration Date:
06/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BOLTIN
Authorized Official First Name:
KELLEY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
307-689-9090

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  1475 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1083985733 . This is a "UNITED HEALTH" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1083985733 . This is a "KID CARE CHIP" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1083985733 . This is a "BLUE CROSS BLUE SHIELD OF WYOMING" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1083985733 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1083985733 . This is a "MERITAIN" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1083985733 . This is a "TRI-CARE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1083985733 . This is a "AETNA" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1083985733 . This is a "CIGNA" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1083985733 . This is a "UBH" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1083985733 . This is a "UNHC" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 1083985733 . This is a "IHC" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com