1639593080 NPI number — CAPITOL COUNSELING, LLC

Table of content: (NPI 1639593080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639593080 NPI number — CAPITOL COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL COUNSELING, 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:
1639593080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1918 THOMES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEYENNE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82001-3527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-631-5574
Provider Business Mailing Address Fax Number:
307-514-5751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1918 THOMES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEYENNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82001-3527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-631-5574
Provider Business Practice Location Address Fax Number:
307-514-5751
Provider Enumeration Date:
02/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WRIEDT-BYRNE
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
307-631-5574

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC-824 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC-483 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC-1425 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCSW-575 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1972604874 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700841681 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1578735940 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1912347469 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1508016023 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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