# LIFESTANCE HEALTH - WYOMING, LLC DBA LIFESTANCE HEALTH

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

## Provider details

- **NPI number:** 1306776554
- **Authorized official:** RYAN PARDO (CHIEF LEGAL OFFICER)
- **Authorized official phone:** (206) 399-1493

## Contact information

- **Practice address:** 2232 DELL RANGE BLVD STE 318, CHEYENNE, WY 82009-4902
- **Practice address phone:** (307) 910-3730
- **Mailing address:** 4800 N SCOTTSDALE RD STE 2500, SCOTTSDALE, AZ 85251-7630

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 103T00000X | Psychologist | — | — | — |
| 104100000X | Social Worker | — | — | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | — |
| 2084B0040X | Behavioral Neurology & Neuropsychiatry Physician | — | — | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/20/2026
- **Last updated:** 09/24/2026