Healthcare Provider Details

I. General information

NPI: 1780712380
Provider Name (Legal Business Name): HIGH COUNTRY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W MAPLE ST
RAWLINS WY
82301-5447
US

IV. Provider business mailing address

721 W MAPLE ST
RAWLINS WY
82301-5447
US

V. Phone/Fax

Practice location:
  • Phone: 307-324-7156
  • Fax: 307-328-1651
Mailing address:
  • Phone: 307-324-7156
  • Fax: 307-328-1651

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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateWY

VIII. Authorized Official

Name: SHANNON NIZER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 307-885-9888