Provider Demographics
NPI:1902399389
Name:SERENITY COUNSELING & MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:SERENITY COUNSELING & MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOLEJACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-509-9890
Mailing Address - Street 1:747 PATCHES
Mailing Address - Street 2:
Mailing Address - City:CARPENTER
Mailing Address - State:WY
Mailing Address - Zip Code:82054-9403
Mailing Address - Country:US
Mailing Address - Phone:307-509-9890
Mailing Address - Fax:307-316-0469
Practice Address - Street 1:747 PATCHES
Practice Address - Street 2:
Practice Address - City:CARPENTER
Practice Address - State:WY
Practice Address - Zip Code:82054-9403
Practice Address - Country:US
Practice Address - Phone:307-509-9890
Practice Address - Fax:307-316-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty