# JACKSON HOLE MENTAL HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053704726
- **Authorized official:** LEAH C BLACK LCSW (OWNER/EXECUTIVE DIRECTOR)
- **Authorized official phone:** (307) 654-7003

## Contact information

- **Practice address:** 310 E BROADWAY AVE, JACKSON, WY 83001-8636
- **Practice address phone:** (307) 654-7003
- **Mailing address:** PO BOX 13572, JACKSON, WY 83002-3572
- **Mailing address phone:** (307) 654-7003

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 742 | WY | Yes |

## Other

- **Enumeration date:** 03/05/2015
- **Last updated:** 04/01/2024