Healthcare Provider Details

I. General information

NPI: 1891099545
Provider Name (Legal Business Name): HIGH COUNTRY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 OVERTHRUST RD STE 105
EVANSTON WY
82930-5205
US

IV. Provider business mailing address

PO BOX 2910
EVANSTON WY
82931-2910
US

V. Phone/Fax

Practice location:
  • Phone: 307-789-4224
  • Fax: 307-789-4225
Mailing address:
  • Phone: 307-789-4224
  • Fax: 307-789-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberLPC-550
License Number StateWY
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberLAT-220
License Number StateWY
# 6
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. KIPP L DANA
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC, LAT
Phone: 307-885-9883