Jackson Hole Mental Health LLC
NPI 1053704726ActiveOrganization· Social Worker, Clinical· Jackson, WY
Social Worker, Clinical in Jackson, Wyoming, registered in NPPES in March 2015. The authorized official on file is Leah C. Black, LCSW, Owner/Executive Director. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1053704726 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 5, 2015 |
| Last updated in NPPES | Apr 1, 2024 |
| Certified by provider | Apr 1, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | 742 | WY |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (WY) |
|---|
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