| Wild Roots Counseling Llc | |
|
337 Robert St Cody WY 82414-9268 | |
| (307) 899-2492 | |
| Not Available |
| Full Name | Wild Roots Counseling Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 337 Robert St, Cody, Wyoming |
| Authorized Official Name and Position | Jamaica Santos Moulton (OWNER) |
| Authorized Official Contact | 3072545048 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Roots Counseling Llc Po Box 2772 Cody WY 82414-2772 Ph: (307) 899-2492 | Wild Roots Counseling Llc 337 Robert St Cody WY 82414-9268 Ph: (307) 899-2492 |
| NPI Number | 1790484889 |
|---|---|
| Provider Enumeration Date | 02/27/2023 |
| Last Update Date | 05/28/2024 |
| Certification Date | 05/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790484889 | NPI | - | NPPES |
| 1326474156 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
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