# HIGH COUNTRY BEHAVIORAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710269048
- **Authorized official:** KIPP DANA LPC, LAT (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (307) 885-9883

## Contact information

- **Practice address:** 389 ADAMS STREET, AFTON, WY 83110-0376
- **Practice address phone:** (307) 885-9883
- **Practice address fax:** (307) 885-5206
- **Mailing address:** PO BOX 376, AFTON, WY 83110-0376
- **Mailing address phone:** (307) 885-9883
- **Mailing address fax:** (307) 885-5206

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | NULL | — |
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | — | — | — |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | LAT-220 | WY | — |
| 261QR0800X | Recovery Care Clinic/Center | — | NULL | Yes |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |

## Other

- **Enumeration date:** 09/13/2011
- **Last updated:** 06/07/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1457472754 | — | WY |