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JACKSON HOLE MENTAL HEALTH LLC
NPI 1053704726
Social Worker - Clinical in Jackson, WY

Active since March 05, 2015
310 E BROADWAY AVE, JACKSON, WY 83001(307) 654-7003 Get Directions Write a Review

NPPES record last updated: April 1, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Jackson Hole Mental Health Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON HOLE MENTAL HEALTH LLC (NPI 1053704726) is a healthcare organization registered as a clinical in Jackson, Wyoming and active in the NPI registry since March 2015. The organization lists Leah C Black, Owner/executive Director, as its authorized official.

NPPES Registry Identity

NPI1053704726
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameJACKSON HOLE MENTAL HEALTH LLC
Location Address310 E BROADWAY AVEJackson, WY 83001-8636
Mailing AddressPo Box 13572Jackson, WY 83002-3572 · (307) 654-7003
Phone(307) 654-7003
Organization SubpartNo
Authorized OfficialLeah C BlackOwner/executive Director · (307) 654-7003
Enumeration DateMarch 5, 2015
Last NPPES UpdateApril 1, 2024
NPPES CertifiedApril 1, 2024
✔ NPI 1053704726 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in WY · 742
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
310 E BROADWAY AVE, Jackson, WY 83001
Open in Google Maps ↗

Other Identifiers 1

Medicaid130859900WY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of Wyoming.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jackson Hole Mental Health Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Jackson Hole Mental Health LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Leah Black, LCSW
Clinical Social Worker
NPI 1003107731
310 E BROADWAY AVE
Jackson, WY 83001
(307) 654-7003
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Hole Mental Health LLC's NPI number?

The NPI number for Jackson Hole Mental Health LLC is 1053704726. It was assigned to this organization in the NPPES registry on March 5, 2015.

Where is Jackson Hole Mental Health LLC located?

Jackson Hole Mental Health LLC is located at 310 E Broadway Ave, Jackson, WY 83001. The listed phone number is (307) 654-7003.

What is Jackson Hole Mental Health LLC's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Jackson Hole Mental Health LLC enrolled in Medicare?

Yes. Jackson Hole Mental Health LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Jackson Hole Mental Health LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Social Worker) reassigns their Medicare billing to Jackson Hole Mental Health LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Jackson Hole Mental Health LLC accept?

Health plans from Blue Cross Blue Shield of Wyoming list Jackson Hole Mental Health LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jackson Hole Mental Health LLC was last updated on April 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.