Amanda Roth, LLC
Organization Active NPI Mental Health Counselor · Cody, WY
NPI 1295448256 · NPPES record last updated Jan 4, 2023
Key facts
- NPI
- 1295448256
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Legal business name
- AMANDA ROTH, LLC
- Practice address
- 956 12TH St
Cody, WY 82414-3602 - Phone
- (307) 751-5111
- Fax
- (307) 587-4014
- NPI assigned
- Jan 4, 2023
- Organization subpart
- No
Authorized official
- Name
- Amanda Roth, LPC
- Title
- Owner / Counselor
- Phone
- (307) 751-5111
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240322000382 | WY | Part B Supplier - Clinic/Group Practice | 0749627057 |
Receives reassigned benefits from 1 practitioner Practice locations: Cody, WY |
National Provider Directory
Locations
956 12th St
Cody, WY 82414
Phone (307) 355-9266
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | Yes | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Adult Mental Health Clinic/Center | 261QM0850X | |||
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X |
Addresses
Primary practice location
956 12TH St
Cody, WY 82414-3602
Mailing address
956 12TH St
Cody, WY 82414-3602
Phone (307) 751-5111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LPC-2124 | Other | WY | MENTAL HEALTH PROFESSIONALS LICENSING BOARD |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | amandaroth.llc@proton.me |
Other providers in Cody, WY
- Patrick Joseph Allen
- Alliance Christian Counseling, LLC
- Kirsten Allphin
- Alpine Medical
- Alternative Specialties, LLC
- Christina Maria Amarillas
- Amanda Ambrose
- Tracey Ambrose
- Aidan Amtmann
- Richard D. Anderson
All providers in Cody, 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 4, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.