NPIMap

Organization Active NPI

Mental Health Managed LLC

  • Professional Counselor
  • Sheridan, WY
National Provider Identifier
1740003235
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
MENTAL HEALTH MANAGED LLC
Practice address
30 N Gould St Ste 42472
Sheridan, WY 82801-6317
Phone
(903) 267-4023
Fax
(903) 487-0600
NPI assigned
Nov 4, 2024
Last updated
Mar 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Authorized official

Name
Brittainy Wagner, LPCNPI 1023429750
Title
Coo
Phone
(903) 267-4023

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X NU
Counselor 101Y00000X NU
Mental Health Counselor 101YM0800X NU
Professional Counselor 101YP2500X NU Primary
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X NU
Psychiatry Physician 2084P0800X NU

Addresses

Primary practice location

30 N Gould St Ste 42472
Sheridan, WY 82801-6317

Mailing address

1431 W Woodard St
Denison, TX 75020-3449
Phone (903) 267-4023

Other practice location 1

270 Trace Colony Park Dr Ste B
Ridgeland, MS 39157-8810
Phone (903) 213-1005

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1730678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741651200000",
    "number": "1740003235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 W WOODARD ST",
            "city": "DENISON",
            "state": "TX",
            "postal_code": "750203449",
            "telephone_number": "903-267-4023",
            "fax_number": "903-487-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N GOULD ST STE 42472",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828016317",
            "telephone_number": "903-267-4023",
            "fax_number": "903-487-0600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "270 Trace Colony Park Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Ridgeland",
            "state": "MS",
            "postal_code": "391578810",
            "country_code": "US",
            "telephone_number": "903-213-1005",
            "fax_number": "903-487-0600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MENTAL HEALTH MANAGED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-04",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "BRITTAINY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "903-267-4023",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheridan, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.