SOMATIC REVELATIONS, LLC (NPI# 1285251967) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285251967 |
| Entity Type | Organization |
| Organization Name | SOMATIC REVELATIONS, LLC |
| Practice Address |
2020 E Grand Ave Ste 506 Laramie WY 82070-4370 |
| Mailing Address |
Po Box 594 Laramie WY 82073-0594 |
| Practice Telephone | 3072009228 |
| Practice Fax Number | 3074609084 |
| Mailing Telephone | 3072009228 |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2020-06-29 |
| Authorized Official Name | TYLER S. TEDMON-JONES (OWNER/OPERATOR) |
| Authorized Official Telephone | 4127602447 |
| Authorized Official Credential | MA, LPC, BC-DMT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225600000X | Dance Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
2020 E GRAND AVE STE 506 |
| City | LARAMIE |
| State | WY |
| Zip Code | 82070-4370 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023526225 | Nikki Marie Rossetter | Counselor | 2020 E Grand Ave Ste 506, Laramie, WY 82070-4383 | 2018-01-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548875164 | Roland Maldonado | Registered Nurse | 258 Nth Hayes Street, Laramie, WY 82070 | 2020-09-10 |
| 1528429917 | Spark | Community/Behavioral Health | 903 S 9th Street, Laramie, WY 82070 | 2016-03-11 |
| 1578968509 | Melissa Marie Allen | Speech-Language Pathologist | 1613 Clydesdale, Laramie, WY 82070 | 2014-11-04 |
| 1316362155 | Charles M. Alexander | Pharmacist | 3112 E. Grand Ave, Laramie, WY 82070 | 2014-03-04 |
| 1447685706 | Dale Warren Van Wig | Pharmacist | 544 N. Third St, Pharmacy, Laramie, WY 82070 | 2013-09-05 |
| 1558619973 | Sarah Marie Pence | Pharmacist | 4005 East Grand Ave, Laramie, WY 82070 | 2012-08-15 |
| 1437435567 | Stephanie Ingalls | Case Manager/Care Coordinator | 69 Osprey Rd., Laramie, WY 82070 | 2011-11-03 |
| 1457634040 | The Clinic for Mental Health and Wellness | Counselor | 504 South 4th Street, Laramie, WY 82070 | 2011-09-21 |
| 1316177371 | Patricia Ann Casey | Occupational Therapist | Laramie Care Center, 503 S. 18th St., Laramie, WY 82070 | 2009-07-23 |
| 1134322340 | Linda K Cross | Case Manager/Care Coordinator | 315 So 8th, Laramie, WY 82070 | 2007-06-06 |
| Find all providers in zip 82070 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073055174 | Gina Sigel | Counselor | 903 S 9th St, Laramie, WY 82070-4602 | 2016-11-07 |
| 1457634040 | The Clinic for Mental Health and Wellness | Counselor | 504 South 4th Street, Laramie, WY 82070 | 2011-09-21 |
| 1952693186 | Meaghan Christine Nolte | Counselor | 710 E Garfield St Ste 242, Laramie, WY 82070-3986 | 2011-05-05 |
| 1730498346 | Tyler S. Tedmon-jones | Counselor | 507 S 4th St Ste B-2, Laramie, WY 82070-3753 | 2010-09-29 |
| 1356673297 | Aaron Lozano | Counselor | 1465 N. 4th Street #119, Laramie, WY 82072 | 2010-02-03 |
| 1659558807 | Tanaya Moon Morris | Counselor | 1465 N 4th St Ste 119, Laramie, WY 82072-2066 | 2008-01-29 |
| 1699808493 | Sylvia Fleming Crocker | Counselor | 2115 E Hancock St, Laramie, WY 82072-2935 | 2007-03-13 |
| 1962540070 | Mitch Ion Gerharter | Counselor | 1910 E Garfield St, Laramie, WY 82070-4335 | 2007-02-01 |
| 1326193095 | Christine Jones | Counselor | 17 Lakeview Rd, Laramie, WY 82070-8578 | 2007-01-24 |
| 1952415796 | Lou Victor Farley | Counselor | 410 E Grand Ave Ste 307, Laramie, WY 82070-3715 | 2006-08-18 |
| Find all providers in LARAMIE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.