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Organization
AMANDA ROTH, LLC
Active
Organization
AMANDA ROTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA ROTH LPC (OWNER / COUNSELOR)
(307) 751-5111
Entity
Organization
Contact information
Practice address
956 12TH ST, CODY, WY 82414-3602
(307) 751-5111
(307) 587-4014
Mailing address
956 12TH ST, CODY, WY 82414-3602
(307) 751-5111
(307) 587-4014
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC-2124
MENTAL HEALTH PROFESSIONALS LICENSING BOARD
WY
Enumeration date
01/04/2023
Last updated
01/04/2023
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