| Full Name | Amanda Roth, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 956 12th St, Cody, Wyoming |
| Authorized Official Name and Position | Amanda Roth (OWNER / COUNSELOR) |
| Authorized Official Contact | 3077515111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda Roth, Llc 956 12th St Cody WY 82414-3602 Ph: (307) 751-5111 | Amanda Roth, Llc 956 12th St Cody WY 82414-3602 Ph: (307) 751-5111 |
| NPI Number | 1295448256 |
|---|---|
| Provider Enumeration Date | 01/04/2023 |
| Last Update Date | 01/04/2023 |
| Certification Date | 01/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295448256 | NPI | - | NPPES |
| LPC-2124 | Other | WY | MENTAL HEALTH PROFESSIONALS LICENSING BOARD |
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› Verified 3 days ago
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