| Amanda Roth, Llc | |
|
956 12th St Cody WY 82414-3602 | |
| (307) 751-5111 | |
| (307) 587-4014 |
| Full Name | Amanda Roth, Llc |
|---|---|
| Speciality | Counselor |
| Location | 956 12th St, Cody, Wyoming |
| Authorized Official Name and Position | Amanda Roth (OWNER / COUNSELOR) |
| Authorized Official Contact | 3077515111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda Roth, Llc 956 12th St Cody WY 82414-3602 Ph: (307) 751-5111 | Amanda Roth, Llc 956 12th St Cody WY 82414-3602 Ph: (307) 751-5111 |
| NPI Number | 1295448256 |
|---|---|
| Provider Enumeration Date | 01/04/2023 |
| Last Update Date | 01/04/2023 |
| Certification Date | 01/04/2023 |
| Medicare PECOS PAC ID | 0749627057 |
|---|---|
| Medicare Enrollment ID | O20240322000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295448256 | NPI | - | NPPES |
| LPC-2124 | Other | WY | MENTAL HEALTH PROFESSIONALS LICENSING BOARD |
| Provider Name | Amanda Colleen Roth |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861032724 PECOS PAC ID: 1658718960 Enrollment ID: I20240322000434 |
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