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General NPI Number Information
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NPI Number | 1710269048
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Entity Type | Organization
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Legal Business Name | HIGH COUNTRY BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 389 ADAMS STREET
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City | AFTON
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State | WY
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Zip | 83110-0376
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Country | US
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Telephone | 307-885-9883
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Fax | 307-885-5206
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Provider Business Mailing Address
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Address Line | PO BOX 376
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City | AFTON
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State | WY
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Zip | 83110-0376
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Country | US
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Telephone | 307-885-9883
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Fax | 307-885-5206
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIPP DANA
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Credential | LPC, LAT
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Telephone | 307-885-9883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | LAT-220
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License Number State | WY
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Taxonomy #5
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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