Basic Information
| Provider Information | |||||||||
| NPI: | 1932458734 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A POSITIVE SOLUTION COUNSELING CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 W LAKEWAY RD | ||||||||
| Address2: | SUITE 1004 | ||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827186361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076823747 | ||||||||
| FaxNumber: | 3076823748 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 W LAKEWAY RD | ||||||||
| Address2: | SUITE 1004 | ||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827186361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076823747 | ||||||||
| FaxNumber: | 3076823748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2012 | ||||||||
| LastUpdateDate: | 09/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | MORISETTE | ||||||||
| AuthorizedOfficialFirstName: | BONITA | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3076823747 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MSW, LCSW-462 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 516 | WY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 1041C0700X | 462 | WY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | 170 | WY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103T00000X | 386 | WY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.