Healthcare Provider Details

I. General information

NPI: 1679388607
Provider Name (Legal Business Name): HIGH COUNTRY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 VAN NOY PKWY
THAYNE WY
83127
US

IV. Provider business mailing address

PO BOX 376
AFTON WY
83110-0376
US

V. Phone/Fax

Practice location:
  • Phone: 307-885-9883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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