Healthcare Provider Details

I. General information

NPI: 1336583608
Provider Name (Legal Business Name): CHOICES , ALCOHOL, DRUG & BEHAVIORAL HELP CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 COUNTY ROAD 109
EVANSTON WY
82930-9797
US

IV. Provider business mailing address

77 COUNTY ROAD 109
EVANSTON WY
82930-9797
US

V. Phone/Fax

Practice location:
  • Phone: 307-783-1088
  • Fax: 307-783-1028
Mailing address:
  • Phone: 307-783-1088
  • Fax: 307-783-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberLAT-199
License Number StateWY

VIII. Authorized Official

Name: MS. MARY HANSEN BOAL
Title or Position: CO-DIRECTOR
Credential: BSW NCACII LAT
Phone: 307-783-1088