Healthcare Provider Details

I. General information

NPI: 1497649875
Provider Name (Legal Business Name): DRIFTLINE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N GOULD ST STE R
SHERIDAN WY
82801-6317
US

IV. Provider business mailing address

800 S 3RD ST
LANDER WY
82520-3712
US

V. Phone/Fax

Practice location:
  • Phone: 518-921-1787
  • Fax:
Mailing address:
  • Phone: 518-921-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BARRETT
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 518-921-1787