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General NPI Number Information
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NPI Number | 1861577140
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Entity Type | Organization
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Legal Business Name | CLOUD PEAK COUNSELING CENTER
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 401 S 23RD ST
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City | WORLAND
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State | WY
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Zip | 82401
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Country | US
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Telephone | 307-347-6165
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Fax | 307-347-6166
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Provider Business Mailing Address
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Address Line | 401 S 23RD ST
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City | WORLAND
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State | WY
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Zip | 82401
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Country | US
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Telephone | 307-347-6165
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Fax | 307-347-6166
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Authorized Official
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Title or Position | CEO
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Name | MARY JEAN JOHNSON
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Credential |
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Telephone | 307-250-2369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State | WY
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | WY
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