| Fern Ridge Counseling, Llc | |
|
1120 Beck Ave Cody WY 82414-3624 | |
| (307) 578-7601 | |
| Not Available |
| Full Name | Fern Ridge Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1120 Beck Ave, Cody, Wyoming |
| Authorized Official Name and Position | Neisha M Potter (OWNER, THERAPIST) |
| Authorized Official Contact | 3075787601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fern Ridge Counseling, Llc 1120 Beck Ave Cody WY 82414-3624 Ph: (307) 250-0194 | Fern Ridge Counseling, Llc 1120 Beck Ave Cody WY 82414-3624 Ph: (307) 578-7601 |
| NPI Number | 1124521547 |
|---|---|
| Provider Enumeration Date | 03/12/2018 |
| Last Update Date | 08/24/2021 |
| Certification Date | 08/24/2021 |
| Medicare PECOS PAC ID | 0941563183 |
|---|---|
| Medicare Enrollment ID | O20180420002018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124521547 | NPI | - | NPPES |
| 149339600 | Medicaid | WY | |
| 143514100 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW-1090 (Wyoming) | Primary |
| Provider Name | Neisha M Potter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275997470 PECOS PAC ID: 0244592277 Enrollment ID: I20180402001993 |
| Provider Name | Angelia Dawn Lomu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336633577 PECOS PAC ID: 6800149402 Enrollment ID: I20181029002902 |
| Provider Name | Adrienne O'neal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205431921 PECOS PAC ID: 3476944166 Enrollment ID: I20220107001214 |
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