NPIMap

Organization Active NPI

High Country Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pinedale, WY
National Provider Identifier
1508058173
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
HIGH COUNTRY BEHAVIORAL HEALTH
Practice address
24 Country Club Lane
Pinedale, WY 82941-0856
Phone
(307) 367-2111
Fax
(307) 367-2166
NPI assigned
Aug 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Authorized official

Name
Mr. Kipp L Dana, LPC, LAT
Title
Executive Director
Phone
(307) 885-9883

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X WY Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X LPC-550 WY
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X WY
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X LAT-220 WY
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

24 Country Club Lane
Pinedale, WY 82941-0856

Mailing address

PO Box 856
Pinedale, WY 82941-0856
Phone (307) 367-2111

Other identifiers 2

IdentifierTypeStateIssuer
117826100MedicaidWY
117847400MedicaidWY

Other names 1

  • High Country Counseling and Resource Centers Former legal business name

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1187222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654646400000",
    "number": "1508058173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 856",
            "city": "PINEDALE",
            "state": "WY",
            "postal_code": "829410856",
            "telephone_number": "307-367-2111",
            "fax_number": "307-367-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 COUNTRY CLUB LANE",
            "city": "PINEDALE",
            "state": "WY",
            "postal_code": "829410856",
            "telephone_number": "307-367-2111",
            "fax_number": "307-367-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGH COUNTRY BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-16",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A",
        "authorized_official_last_name": "DANA",
        "authorized_official_first_name": "KIPP",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "307-885-9883",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC, LAT"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WY",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WY",
            "license": "LPC-550",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WY",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WY",
            "license": "LAT-220",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117826100",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117847400",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "High Country Counseling and Resource Centers",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "High Country Counseling and Resource Centers",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Pinedale, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; 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.