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Organization
JACKSON HOLE MENTAL HEALTH LLC
Active
Organization
JACKSON HOLE MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEAH C BLACK LCSW (OWNER/EXECUTIVE DIRECTOR)
(307) 654-7003
Entity
Organization
Contact information
Practice address
310 E BROADWAY AVE, JACKSON, WY 83001-8636
(307) 654-7003
Mailing address
PO BOX 13572, JACKSON, WY 83002-3572
(307) 654-7003
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
742
WY
Other
Enumeration date
03/05/2015
Last updated
04/01/2024
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