| Provider / Organization | NPI | Date Certified |
|---|---|---|
| AMANDA COLLEEN ROTH | 1861032724 | 2023-01-21 |
Amanda Colleen Roth is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1861032724. Registration indicates Amanda Colleen Roth is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Counselor (Behavioral Health & Social Service Providers, Counselor) (Counselor: Professional, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Counselor Professional, Behavioral Health & Social Service Providers) (Counselor, )
| Entity Type | Individual |
| Provider Name | Amanda Colleen Roth |
| Practice Office Address | 956 12TH ST CODY, WY US |
| Practice Office Telephone | 3077515111 |
| Practice Office Fax | 3075874014 |
| Mailing Address | 326 34TH ST CODY, WY 824149271 US |
| Business Telephone | 3077515111 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 2538 Big Horn Ave | Cody, WY 824149299 | 3075872197 |
| Code | Practice | License No State |
|---|---|---|
| 101YP2500X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Counselor Behavioral Health & Social Service Providers Counselor Counselor: Professional Behavioral Health/Substance Abuse/Psychiatry Counselor Professional Behavioral Health & Social Service Providers Counselor | LPC-2124
WY |