| Eagle Rock Counseling Services Llc. | |
| 
					235 E Main St Lovell WY 82431-2101  | |
| (307) 272-8798 | |
| Not Available | 
| Full Name | Eagle Rock Counseling Services Llc. | 
|---|---|
| Speciality | Counselor | 
| Location | 235 E Main St, Lovell, Wyoming | 
| Authorized Official Name and Position | Charles Cordova (OWNER) | 
| Authorized Official Contact | 3072728798 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Eagle Rock Counseling Services Llc. 730 Montana Ave Lovell WY 82431-1810 Ph: (307) 272-8798  | Eagle Rock Counseling Services Llc. 235 E Main St Lovell WY 82431-2101 Ph: (307) 272-8798  | 
| NPI Number | 1699537894 | 
|---|---|
| Provider Enumeration Date | 01/24/2024 | 
| Last Update Date | 02/29/2024 | 
| Certification Date | 02/29/2024 | 
| Medicare PECOS PAC ID | 9234574245 | 
|---|---|
| Medicare Enrollment ID | O20240229002576 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1699537894 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary | 
| Provider Name | Charles Joseph Cordova | 
|---|---|
| Provider Type | Practitioner - Mental Health Counselor | 
| Provider Identifiers | NPI Number: 1073978920 PECOS PAC ID: 0143665158 Enrollment ID: I20240229002661  | 
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