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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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