Provider Demographics
NPI:1720346778
Name:WARDELL CONSULTING GROUP, LLC
Entity type:Organization
Organization Name:WARDELL CONSULTING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:WARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DBH
Authorized Official - Phone:405-412-5468
Mailing Address - Street 1:301 THELMA DR # 226
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2325
Mailing Address - Country:US
Mailing Address - Phone:405-412-5468
Mailing Address - Fax:
Practice Address - Street 1:940 E 3RD ST STE 105
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3200
Practice Address - Country:US
Practice Address - Phone:405-412-5468
Practice Address - Fax:405-302-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200236790AMedicaid