| Open Space Counseling Services Llc | |
|
956 12th St Cody WY 82414-3602 | |
| (307) 272-2534 | |
| Not Available |
| Full Name | Open Space Counseling Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 956 12th St, Cody, Wyoming |
| Authorized Official Name and Position | Jessica Williams (OWNER) |
| Authorized Official Contact | 3072722534 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Open Space Counseling Services Llc 956 12th St Cody WY 82414-3602 Ph: (307) 272-2534 | Open Space Counseling Services Llc 956 12th St Cody WY 82414-3602 Ph: (307) 272-2534 |
| NPI Number | 1952943961 |
|---|---|
| Provider Enumeration Date | 10/10/2019 |
| Last Update Date | 10/10/2019 |
| Medicare PECOS PAC ID | 6800241993 |
|---|---|
| Medicare Enrollment ID | O20231010001089 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952943961 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Amber Shier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730709437 PECOS PAC ID: 5092161166 Enrollment ID: I20231025002394 |
| Provider Name | Tiana Ellison |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871984476 PECOS PAC ID: 1951742956 Enrollment ID: I20240508001567 |
| Provider Name | Jessica Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073979076 PECOS PAC ID: 1254786346 Enrollment ID: I20240531001037 |
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