Provider Demographics
NPI:1457173031
Name:BUFFALO RIDGE COUNSELING LLC
Entity type:Organization
Organization Name:BUFFALO RIDGE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LAT
Authorized Official - Phone:307-254-0007
Mailing Address - Street 1:3105 GOLDENROD AVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-2287
Mailing Address - Country:US
Mailing Address - Phone:307-254-0007
Mailing Address - Fax:
Practice Address - Street 1:1901 ENERGY CT STE 170
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5574
Practice Address - Country:US
Practice Address - Phone:307-254-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty