Healthcare Provider Details

I. General information

NPI: 1144373440
Provider Name (Legal Business Name): BIG HORN BASIN COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 SOUTH 3RD
BASIN WY
82410
US

IV. Provider business mailing address

1114 LANE 12
LOVELL WY
82431-9555
US

V. Phone/Fax

Practice location:
  • Phone: 307-568-2020
  • Fax: 307-568-2503
Mailing address:
  • Phone: 307-548-6543
  • Fax: 307-548-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateWY

VIII. Authorized Official

Name: MRS. AUTUMN MARIE SNYDER
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 307-548-6543