Organization
HIGH COUNTRY BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIPP DANA LPC, LAT (EXECUTIVE DIRECTOR)
(307) 885-9883
Entity
Organization
Contact information
Practice address
389 ADAMS STREET, AFTON, WY 83110-0376
(307) 885-9883
(307) 885-5206
Mailing address
PO BOX 376, AFTON, WY 83110-0376
(307) 885-9883
(307) 885-5206
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
LAT-220
WY
261QR0800X
Recovery Care Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457472754
—
WY
Enumeration date
09/13/2011
Last updated
06/07/2024
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