Wild Roots Counseling LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

WILD ROOTS COUNSELING LLC

Practice address

337 Robert St
Cody, WY 82414-9268

Phone

(307) 899-2492

NPI assigned

Feb 27, 2023

Last updated

May 28, 2024By 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

Jamaica Santos Moulton, LPCNPI 1326474156

Title

Owner

Phone

(307) 254-5048

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 1

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.

• Jamaica Santos Moulton, LPC

  • Professional Counselor
  • Cody, WY
  • NPI 1326474156
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1790484889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2772",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824142772",
            "telephone_number": "307-899-2492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "337 ROBERT ST",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824149268",
            "telephone_number": "307-899-2492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD ROOTS COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-27",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "MOULTON",
        "authorized_official_first_name": "JAMAICA",
        "authorized_official_middle_name": "SANTOS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-254-5048",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326474156",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra E Whalen, C.R.N.A.
• Robert Scott White, D.O.
• Alyssa Jo Whitlock
• Sarah Elizabeth Whitlock, FNP-C
• Sally J Whitman, PA-C
• Derek Paul Wille, MD
• William H. and Carrie Gottsche Foundation
• Brandon Williams
• Jennifer L. Williams, PAC
• Jessica Williams, LPC

• Mental Health Counselor in Cody, WY
• Providers in Cody, WY by specialty
• Mental Health Counselor in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; 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.