Lisa Otto, LCSW LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

LISA OTTO, LCSW LLC

Practice address

121 E Grand Ave Ste 209
Laramie, WY 82070-3652

Phone

(307) 760-2517

NPI assigned

Apr 26, 2021

Last updated

Apr 26, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Otto, LCSWNPI 1851707574

Title

Ceo

Phone

(307) 760-2517

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lisa Otto

  • Mental Health Counselor
  • Cheyenne, WY
  • NPI 1851707574

  Single Specialty

  Medicare reassignment NPD Authorized official
• Tessa Matzen, PCSW

  • Clinical Social Worker
  • Cheyenne, WY
  • NPI 1447792593
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619395200000",
    "number": "1356923627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 982",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820730982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 E GRAND AVE STE 209",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820703652",
            "telephone_number": "307-760-2517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA OTTO, LCSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A",
        "authorized_official_last_name": "OTTO",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-760-2517",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1851707574",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "lisaottolcsw@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "121 E Grand Ave Ste 209",
            "city": "Laramie",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820703652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lincare Inc.
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• Joy A Lion
• Presten List-Hanson
• Jennifer Llamas
• Janesa Lockhart
• Patty Jo. Lockhart
• Bryan Loera

• Mental Health Clinic/Center (Including Community Mental Health Center) in Laramie, WY
• Providers in Laramie, WY by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.