1457472748 NPI number — HIGH COUNTRY BEHAVIORAL HEALTH

Table of content: (NPI 1457472748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457472748 NPI number — HIGH COUNTRY BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGH COUNTRY BEHAVIORAL HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HIGH COUNTRY COUNSELING AND RESOURCE CENTERS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457472748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 376
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AFTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
83110-0376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-885-9883
Provider Business Mailing Address Fax Number:
307-885-5206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
389 ADAMS ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AFTON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
83110-0376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-885-9883
Provider Business Practice Location Address Fax Number:
307-885-5206
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DANA
Authorized Official First Name:
KIPP
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
307-885-9883

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 405 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: LPC-550 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: LAT-220 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 117699401 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117847400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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