Active NPI
Jill C Favata, M.S. ED, LPC
- Counselor
- Cheyenne, WY
National Provider Identifier
1972587319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 910
- Practice address
- 2909 Bent Ave
The Healing Center
Cheyenne, WY 82001-2742 - Phone
- (307) 286-5279
- NPI assigned
- Nov 30, 2005
- Last updated
- Jun 30, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 910 | WY | |
| Counselor | 101Y00000X | 910 | WY | Primary |
Addresses
Primary practice location
2909 Bent Ave
The Healing Center
Cheyenne, WY 82001-2742
Mailing address
1213 Taft Ave
Apt. B
Cheyenne, WY 82001-6860
Phone (307) 286-5279
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 312408 | Other | WY | BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 910 | WY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246320000000",
"number": "1972587319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1213 TAFT AVE",
"address_2": "APT. B",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820016860",
"telephone_number": "307-286-5279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2909 BENT AVE",
"address_2": "THE HEALING CENTER",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820012742",
"telephone_number": "307-286-5279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAVATA",
"first_name": "JILL",
"middle_name": "C",
"credential": "M.S. ED, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-11-30",
"last_updated": "2009-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WY",
"license": "910",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WY",
"license": "910",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BS",
"identifier": "312408",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.