Healthcare Provider Details

I. General information

NPI: 1629352406
Provider Name (Legal Business Name): BIG HORN BASIN COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 LANE 12
LOVELL WY
82431-9555
US

IV. Provider business mailing address

1114 LANE 12
LOVELL WY
82431-9555
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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