Provider Demographics
NPI:1316779457
Name:HIGH COUNTRY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:HIGH COUNTRY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-444-4222
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0376
Mailing Address - Country:US
Mailing Address - Phone:307-885-9883
Mailing Address - Fax:
Practice Address - Street 1:905 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225-5208
Practice Address - Country:US
Practice Address - Phone:307-358-2846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care