1144373440 NPI number — BIG HORN BASIN COUNSELING SERVICES

Table of content: (NPI 1144373440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144373440 NPI number — BIG HORN BASIN COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIG HORN BASIN COUNSELING SERVICES
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:
Provider Other Organization Name Type Code:
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:
1144373440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1114 LANE 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELL
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82431-9555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-548-6543
Provider Business Mailing Address Fax Number:
307-548-6565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 SOUTH 3RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BASIN
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-568-2020
Provider Business Practice Location Address Fax Number:
307-568-2503
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SNYDER
Authorized Official First Name:
AUTUMN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
307-548-6543

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106515702 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106515705 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106515706 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106515703 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106515700 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106515701 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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