Amanda Bullock
Individual provider Active NPI Mental Health Counselor · Cheyenne, WY
NPI 1043850811 · NPPES record last updated Jan 9, 2020
Key facts
- NPI
- 1043850811
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- PPC-1166 (WY)
- Practice address
- 2005 Warren Ave
Cheyenne, WY 82001-3725 - Phone
- (307) 426-4855
- NPI assigned
- Jan 9, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
- Opted out of Medicare
- Yes, effective Jun 3, 2026 through Jun 3, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PPC-1166 | WY | MD | Mental Health Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | PPC-1166 | WY | Yes |
Addresses
Primary practice location
2005 Warren Ave
Cheyenne, WY 82001-3725
Mailing address
7308 Legacy Pkwy
Cheyenne, WY 82009-8392
Phone (307) 272-7743
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PPC-1166 | Medicaid | WY |
Other providers in Cheyenne, WY
- Peggy S Bryant
- Erin Buchanan
- Janet L Buchhammer
- Tyson Buffington
- Aydan Bullard
- Gary Bunker
- Dianna L Burchett
- Christy Marie Burd
- Robert Milton Burdett Jr.
- Kim Burdick
All providers in Cheyenne, WY · Mental Health Counselor in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2020. 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).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.