Brain Injury Association of Wyoming
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Casper, WY
NPI 1003220096 · NPPES record last updated May 13, 2025
Key facts
- NPI
- 1003220096
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- BRAIN INJURY ASSOCIATION OF WYOMING
- Practice address
- 350 Big Horn Rd Ste 101
Casper, WY 82601-1782 - Phone
- (307) 473-1767
- NPI assigned
- Jun 17, 2014
- Organization subpart
- No
Authorized official
- Name
- Daniel Cubbedge
- Title
- Executive Director
- Phone
- (307) 473-1767
Practitioners 7
-
Cecilia Marie Stark, PCSW
-
Rachel Taylor, PCSW
-
Ashleigh Tieszen, RBT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250410002722 | WY | Part B Supplier - Clinic/Group Practice | 9638693658 |
Receives reassigned benefits from 2 practitioners Practice locations: Casper, WY |
National Provider Directory
Locations
350 Big Horn Rd
Casper, WY 82601
Phone (307) 473-1767
350 Big Horn Rd
Ste 101
Casper, WY 82601
Phone (307) 473-1767
111 W 2nd St
Ste 106
Casper, WY 82601
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst |
103K00000X | |||
| Social Worker |
104100000X | |||
| Clinical Social Worker |
1041C0700X | |||
| School Social Worker |
1041S0200X | |||
| Assistant Behavior Analyst |
106E00000X | |||
| Behavior Technician |
106S00000X | |||
| Case Manager/Care Coordinator |
171M00000X | |||
| Case Management Agency | 251B00000X | |||
| Developmentally Disabled Services Day Training Agency | 251C00000X | |||
| Community/Behavioral Health Agency | 251S00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes | ||
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X |
Addresses
Primary practice location
350 Big Horn Rd Ste 101
Casper, WY 82601-1782
Mailing address
PO Box 2984
Casper, WY 82602-2984
Phone (307) 473-1767
Other practice location 1
740 Lucker Ln
Evansville, WY 82636-8604
Phone (307) 473-1767
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 214737800 | Medicaid | WY | |
| 221397400 | Medicaid | WY | |
| 139437101 | Medicaid | WY | |
| 139437100 | Medicaid | WY |
Other names
- Brain Injury Advocates of Wyoming
- Brain Injury Alliance of Wyoming
Other providers in Casper, WY
- Bozeman Trail Orthodontics PC
- Luke Edwin Bracke
- Braden Partners LP
- Harold Bradshaw
- Shreya Brahmbhatt
- Theresa A Brandel
- Diane Marie Branson
- Brant Audiology, LLC
- Fantasia Marie Brasmer
- Nicholas James Brattis
All providers in Casper, WY · Mental Health Clinic/Center (Including Community Mental Health Center) in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.