Leah Black, LCSW
Individual provider Active NPI Clinical Social Worker · Jackson, WY
NPI 1003107731 · NPPES record last updated Feb 18, 2015
Key facts
- NPI
- 1003107731
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCSW-742 (WY)
- Practice address
- 310 E Broadway Ave
Jackson, WY 83001-8636 - Phone
- (307) 654-7003
- Fax
- (307) 224-4973
- NPI assigned
- Apr 28, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
310 E Broadway Ave
Jackson, WY 83001-8636
Phone (307) 200-7261
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150617002976 | WY | Practitioner - Clinical Social Worker | 6305167917 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW-742 | WY | MD | Clinical Social Worker |
| 742 | WY | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson Hole Mental Health LLC | Clinical | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW-742 | WY | Yes |
Addresses
Primary practice location
310 E Broadway Ave
Jackson, WY 83001-8636
Mailing address
PO Box 13572
Jackson, WY 83002-3572
Phone (307) 654-7003
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 117699400 | Medicaid | WY |
Other names
- Leah Hurst
Other providers in Jackson, WY
- Bingham Endodontics, PLLC
- Biohealth Inc
- Trudylynn Birkemeyer Funk
- Kelly J Biscombe
- Kimberly Bjorkman
- Blackburn Drug LLC
- James Edward Blackburn Jr.
- Philip C Blum
- Peter G. Blumenauer
- Carol Bocker
All providers in Jackson, WY · Clinical Social Worker in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.