NPIMap

Organization Active NPI

Big Horn Basin Mental Health Group

  • Clinical Psychologist
  • Powell, WY
National Provider Identifier
1366658601
Registry record updated Oct 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
SP03 Issued in WY
Legal business name
BIG HORN BASIN MENTAL HEALTH GROUP
Practice address
1054 Vali Rd
Powell, WY 82435-9259
Phone
(307) 754-3860
NPI assigned
May 15, 2007
Last updated
Oct 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2014

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

Authorized official

Name
Dr. Gibson B. Condie, PH.D.NPI 1750478376
Title
Psychologist
Phone
(307) 754-3860

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X SP03 WY Primary

Addresses

Primary practice location

1054 Vali Rd
Powell, WY 82435-9259

Mailing address

1054 Vali Rd
Powell, WY 82435-9259
Phone (307) 754-3860

Other identifiers 1

IdentifierTypeStateIssuer
124068400MedicaidWY

National Provider Directory

National Provider Directory
Tax ID family
Big Horn Basin Mental Health Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413504000000",
    "number": "1366658601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1054 VALI RD",
            "city": "POWELL",
            "state": "WY",
            "postal_code": "824359259",
            "telephone_number": "307-754-3860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1054 VALI RD",
            "city": "POWELL",
            "state": "WY",
            "postal_code": "824359259",
            "telephone_number": "307-754-3860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG HORN BASIN MENTAL HEALTH GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2014-10-17",
        "status": "A",
        "authorized_official_last_name": "CONDIE",
        "authorized_official_first_name": "GIBSON",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "307-754-3860",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WY",
            "license": "SP03",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124068400",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Powell, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.