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Organization

FERN RIDGE COUNSELING, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. NEISHA M POTTER LCSW (OWNER, THERAPIST)
(307) 578-7601
Entity
Organization

Contact information

Practice address
1120 BECK AVE, CODY, WY 82414-3624
(307) 578-7601
Mailing address
1120 BECK AVE, CODY, WY 82414-3624
(307) 250-0194

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-1090
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
143514100
WY
05
149339600
WY
Enumeration date
03/12/2018
Last updated
08/24/2021
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