NPIMap

Organization Active NPI

High Country Behavioral Health

  • Recovery Care Clinic/Center
  • Evanston, WY
National Provider Identifier
1174805402
Registry record updated Jun 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Recovery Care Clinic/CenterTaxonomy code 261QR0800X
Legal business name
HIGH COUNTRY BEHAVIORAL HEALTH
Practice address
190 Overthrust Rd.
Evanston, WY 82931-2910
Phone
(307) 789-4224
Fax
(307) 789-4225
NPI assigned
Sep 13, 2011
Last updated
Jun 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kipp Dana, LAT, LPCNPI 1386825446
Title
Executive Director
Phone
(307) 885-9883

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X LAT-220 WY
Recovery Care Clinic/Center 261QR0800X NU Primary
Clinical Medical Laboratory 291U00000X NU
Family Medicine Physician 207Q00000X NU
Addiction Medicine (Family Medicine) Physician 207QA0401X NU

Addresses

Primary practice location

190 Overthrust Rd.
Evanston, WY 82931-2910

Mailing address

190 Overthrust Rd.
Evanston, WY 82931-2910
Phone (307) 789-4224

Other identifiers 1

IdentifierTypeStateIssuer
1891099545MedicaidWY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110418000512 WY Part B Supplier - Clinic/Group Practice 0648454587 Receives reassigned benefits from 52 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Glenrock, WY; Thermopolis, WY; Thayne, WY; Rawlins, WY; Pinedale, WY; Lyman, WY; Kemmerer, WY; Afton, WY…

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

National Provider Directory

National Provider Directory
Tax ID family
High Country Behavioral Health27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1841 Madora Ave
Douglas, WY 82633

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717718400000",
    "number": "1174805402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 OVERTHRUST RD.",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829312910",
            "telephone_number": "307-789-4224",
            "fax_number": "307-789-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 OVERTHRUST RD.",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829312910",
            "telephone_number": "307-789-4224",
            "fax_number": "307-789-4225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH COUNTRY BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-13",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A",
        "authorized_official_last_name": "DANA",
        "authorized_official_first_name": "KIPP",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "307-885-9883",
        "authorized_official_credential": "LAT, LPC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WY",
            "license": "LAT-220",
            "primary": false
        },
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891099545",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.