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General NPI Number Information
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NPI Number | 1497649875
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Entity Type | Organization
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Legal Business Name | DRIFTLINE BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 30 N GOULD ST STE R
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City | SHERIDAN
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State | WY
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Zip | 82801-6317
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Country | US
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Telephone | 518-921-1787
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Fax |
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Provider Business Mailing Address
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Address Line | 800 S 3RD ST
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City | LANDER
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State | WY
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Zip | 82520-3712
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Country | US
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Telephone | 518-921-1787
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA BARRETT
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Credential | PMHNP-BC
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Telephone | 518-921-1787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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