High Country Behavioral Health
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Kemmerer, WY
NPI 1972624062 · NPPES record last updated Jun 8, 2022
Key facts
- NPI
- 1972624062
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- License
- LPC-550 (WY)
- Legal business name
- HIGH COUNTRY BEHAVIORAL HEALTH
- Practice address
- 821 Sage Ave
Kemmerer, WY 83101-3127 - Phone
- (307) 877-4466
- Fax
- (307) 877-9832
- NPI assigned
- Apr 3, 2007
- Organization subpart
- No
Authorized official
- Name
- Kipp L Dana, LPC, LAT
- Title
- Executive Director
- Phone
- (307) 885-9883
Other NPIs on the same Medicare enrollment 23
Corporate family (same tax ID) 26
Member organizations 1
Practitioners 4
-
Aaron J. Preece, LPC
-
Mandy Fernandez, LCSW
-
Jaimi N Woolley, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
- Tax ID family
- High Country Behavioral Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Addiction Medicine (Family Medicine) Physician |
207QA0401X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | 405 | WY | |
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | LPC-550 | WY | Yes |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 405 | WY | |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | LAT-220 | WY | |
| Clinical Medical Laboratory | 291U00000X |
Addresses
Primary practice location
821 Sage Ave
Kemmerer, WY 83101-3127
Mailing address
821 Sage Ave
Kemmerer, WY 83101-3127
Phone (307) 877-4466
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 117847400 | Medicaid | WY |
Other names
- High Country Counseling and Resource Centers
Other providers in Kemmerer, WY
- Kyla Ward Franklin
- Johnna Lynn Garcia
- Hilary Anne Greiner
- Regg A Hagge
- High Country Behavioral Health
- Hna, Inc.
- Ihc Health Services Inc
- Dinah James
- Kelsey Lyn Ketelsen
- George Christopher Krell
All providers in Kemmerer, 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 Jun 8, 2022. 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.