Wild Roots Counseling LLC
NPI 1790484889ActiveOrganization· Counselor, Mental Health· Cody, WY
Counselor, Mental Health in Cody, Wyoming, registered in NPPES in February 2023. The authorized official on file is Jamaica Santos Moulton, LPC, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1790484889 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Feb 27, 2023 |
| Last updated in NPPES | May 28, 2024 |
| Certified by provider | May 28, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Counselor, Mental Health Primary | 101YM0800X | — | — |
| Counselor, Professional | 101YP2500X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 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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