Healthcare Provider Details

I. General information

NPI: 1134953490
Provider Name (Legal Business Name): CLOUD PEAK COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2538 BIG HORN AVE
CODY WY
82414-9299
US

IV. Provider business mailing address

2538 BIG HORN AVE
CODY WY
82414-9299
US

V. Phone/Fax

Practice location:
  • Phone: 307-587-2197
  • Fax:
Mailing address:
  • Phone: 307-587-2197
  • Fax:

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 State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KACEY JONES
Title or Position: ADMINISTRATIVE COORDINATOR/RCM LEAD
Credential:
Phone: 307-347-6165