Provider Demographics
NPI:1578370839
Name:RISING TIDES COUNSELING LLC
Entity type:Organization
Organization Name:RISING TIDES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-578-6520
Mailing Address - Street 1:21 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8856
Mailing Address - Country:US
Mailing Address - Phone:307-578-6520
Mailing Address - Fax:
Practice Address - Street 1:1438 SHERIDAN AVE STE 106
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3736
Practice Address - Country:US
Practice Address - Phone:307-578-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)