| Somatic Revelations, Llc | |
|
2020 E Grand Ave Ste 506 Laramie WY 82070-4370 | |
| (307) 200-9228 | |
| (307) 460-9084 |
| Full Name | Somatic Revelations, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2020 E Grand Ave Ste 506, Laramie, Wyoming |
| Authorized Official Name and Position | Tyler S. Tedmon-jones (OWNER/OPERATOR) |
| Authorized Official Contact | 4127602447 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Somatic Revelations, Llc Po Box 594 Laramie WY 82073-0594 Ph: (307) 200-9228 | Somatic Revelations, Llc 2020 E Grand Ave Ste 506 Laramie WY 82070-4370 Ph: (307) 200-9228 |
| NPI Number | 1285251967 |
|---|---|
| Provider Enumeration Date | 06/29/2020 |
| Last Update Date | 06/29/2020 |
| Certification Date | 06/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285251967 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 225600000X | Dance Therapist | (* (Not Available)) | Secondary |
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