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Amanda Roth, Llc
Adolescent and Children Mental Health Clinic/Center in Cody, Wyoming
NPI 1295448256

Amanda Roth, Llc is an Adolescent and Children Mental Health Clinic/Center based in Cody, WY and is specialized in Adolescent and Children Mental Health. Amanda Roth, Llc practices in Cody, WY. The NPI Number for Amanda Roth, Llc is 1295448256 and holds a License No. (Wyoming).

The current practice location address for Amanda Roth, Llc is 956 12Th St, Cody, WY and can be reached out via phone at 307-751-5111 and via fax at 307-587-4014. You can also correspond with Amanda Roth, Llc through the mailing address at 956 12TH ST, CODY, WY - 82414-3602 (mailing address contact number: 307-751-5111).

Location: 956 12Th St, Cody, WY, 82414-3602
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1295448256
Provider Name
Amanda Roth, Llc
Credential
Provider Entity Type
Organization
Address
956 12Th St, Cody, WY, 82414-3602
Phone Number
307-751-5111
Fax Number
307-587-4014
Provider Enumeration Date
01/04/2023
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
LPC-2124 01 WY MENTAL HEALTH PROFESSIONALS LICENSING BOARD
institution
Provider Business Practice Location Address Details
Address
956 12Th St
City
Cody
State
Wyoming
Zip
82414-3602
Phone Number
307-751-5111
Fax Number
307-587-4014
person
Provider Business Mailing Address Details
Address
956 12Th St
City
Cody
State
Wyoming
Zip
82414-3602
Phone Number
307-751-5111
Fax Number
307-587-4014
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Mental Health (Including Community Mental Health Center)
Taxonomy
261QM0801X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adult Mental Health
Taxonomy
261QM0850X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
person
Provider's Taxonomy Details 4
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Adolescent and Children Mental Health
Taxonomy
261QM0855X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
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