MEDICARE: YAMPA VALLEY BEHAVIORAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-15-18017	CO

General Provider Information

NPI Number	:	1093292369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YAMPA VALLEY BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	40595 ANCHOR WAY
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-9567
Country	:	US
Telephone Number	:	303-902-6476
Fax Number	:

Provider Business Practice Location Address
First Line	:	40595 ANCHOR WAY
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-9567
Country	:	US
Telephone Number	:	303-902-6476
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	LAURA JEANNE COPELAND
Credential	:
Telephone Number	:	303-902-6476

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/19/2018

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