Provider Demographics
NPI:1447673082
Name:KROSS FIRE COUNSELING & EQUINE ENTERPRISES
Entity type:Organization
Organization Name:KROSS FIRE COUNSELING & EQUINE ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:RALEY MA
Authorized Official - Last Name:RALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:307-751-3769
Mailing Address - Street 1:919 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5806
Mailing Address - Country:US
Mailing Address - Phone:307-751-3769
Mailing Address - Fax:307-763-4440
Practice Address - Street 1:919 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5806
Practice Address - Country:US
Practice Address - Phone:307-751-3769
Practice Address - Fax:307-763-4440
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. WOJCIECH ZOLCIK MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1076101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty