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General NPI Number Information
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NPI Number | 1871307561
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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 | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 905 S MAIN ST
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City | LUSK
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State | WY
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Zip | 82225-5208
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Country | US
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Telephone | 307-367-2111
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Fax |
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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 |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SHANNON NIZER
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Credential |
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Telephone | 307-885-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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